Rise in vets with AMR concerns about cascade
“Where the cascade is not offering the most appropriate solution, BVA advises vets to use their clinical judgement and consider alternative prescribing options” – Anna Judson.
There is growing concern among veterinary surgeons about antimicrobial resistance when following the cascade to make prescription decisions, the latest Voice of the Veterinary Profession survey has revealed.
The survey, conducted by the British Veterinary Association (BVA), showed that 86 per cent of respondents felt that using the cascade had led to them making at least one prescription decision which did not follow the principles of responsible antimicrobial prescribing. Fifty-eight per cent reported this happening either often or sometimes.
The number of concerned veterinary surgeons has grown since 2018, when the respective figures were 60 per cent and 43 per cent.
The survey also revealed that concerns when using the cascade were more common among veterinary surgeons treating non-traditional companion animals.
BVA has released the findings from the Autumn 2023 Voice of the Veterinary Profession survey as part of World Antimicrobial Awareness Week (18-24 November).
BVA president Anna Judson said: “We know vets want to protect antimicrobials and keep them working against serious and potentially life-threatening infections.
“However, there’s an ongoing concern among our members, especially colleagues who treat minor species or exotics, that it can often be difficult to balance the appropriate use of antibiotics with the cascade. In some circumstances this leads to decisions that could exacerbate antimicrobial resistance.
“Where the cascade is not offering the most appropriate solution, BVA advises vets to use their clinical judgement and consider alternative prescribing options. This should be done on a case-by-case basis and after giving full consideration to potential risks and all available evidence.
“For any off-licence use of antimicrobials, vets can also help extend the body of evidence around antimicrobial safety and efficacy by publishing case studies and pharmacokinetic data where possible.
“We would also like to work with Veterinary Medicines Directorate to find ways to increase licensed options for minor species and exotics, to make it easier for vets to prescribe medications based on evidence-based clinical judgement while stewarding responsible antimicrobial use.”
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Veterinary practices are being urged to help owners safely dispose of any unused and expired pet medicines - not just antibiotics - during November's Animal Medicines Amnesty. 
