College Connection | Summer 2023
Panel provides advice on antimicrobial stewardship
College Connection | Summer 2023
LEARNING IN PRACTICE
Panel provides advice on antimicrobial stewardship
Veterinarians have a responsibility to provide safe , quality care . The College assists veterinarians in doing so when matters are reviewed by the Complaints Committee . The public has a right to ask questions about the care that was provided to their animal ( s ) and this process provides veterinarians with feedback on whether they have met the standards of practice or whether there are improvements needed to mitigate risks in practice . The Committee provides advice or may request a veterinarian enter into an undertaking when remediation would reduce risks and support a veterinarian in meeting the standard of practice . Only the most serious cases , where there is bad intent , incompetence , reckless behaviour , or a history of failure to remediate at-risk behaviour are referred to the Discipline Committee for a discipline hearing to determine if an act of professional misconduct or serious neglect may have occurred . This example is taken from a case that was reviewed by the Complaints Committee and is offered as a self-reflection tool to support veterinarians in understanding how to meet the standards of practice .
Case Summary
The member examined a large dog with an itchy ear . The member noted a round , polyp-like mass in the ear and recommended sedation for further examination . The client declined and a course of Amoxiclav and Metacam was dispensed . The dog was re-examined a month later and the member recommended surgical removal of the polyp and ear cleaning under sedation , as well as long term use of Amoxiclav and Cetrizine to reduce itch and manage the mass .
The client obtained a second opinion which determined the dog had an external yeast otitis . The dog was treated with Surolan and the ear issues resolved .
The case centred around the dog unnecessarily receiving antibiotic treatment and the recommendation for an unnecessary surgery . Other concerns focused on the member ’ s unprofessional response to a negative Google review posted by the client .
Case Outcomes
The Complaints Committee panel decided the allegations made against the member did not warrant a referral to the Discipline Committee . The panel decided to provide the member with advice about antimicrobial stewardship .
Case Considerations
In consideration of this complaint , a panel of the Complaints Committee reviewed the medical records and written submissions from the client , and the member . As is standard for all investigations , the panel considered previous proceedings , if any .
The panel was concerned about the member ’ s recommendation for long term use of oral antibiotics to treat the ear . The panel noted the prescribed Apo-Amoxiclav 500 / 125mg at 1.5 tablets twice daily , was much higher than the typical 12.5mg / kg dose recommended and prescribed by most veterinarians . While this dose was within the acceptable range , the panel disagreed it would be considered a low dose or that it was appropriate for long term use for the dog ’ s condition .
The panel was concerned the member did not follow best practice for antimicrobial stewardship . Because of antimicrobial drug resistance , the need to assess the appropriateness of antibiotics before initiating antimicrobial drug treatment is more important than ever . Overuse of antimicrobial drugs is wasteful of client resources and risks selection for antimicrobial-resistant bacteria that may be harmful to the pet , other animals , and also the humans who are in contact with the animal . The overuse of antibiotics in human and veterinary medicine and in food-production has contributed to the emergence of antibiotic-resistant strains of bacteria around the world .
Veterinarians are responsible for exercising appropriate discretion and professional judgment when prescribing antibiotics .
On the surgery recommendation , the panel agreed with the member ’ s response that the client was provided with the possible outcomes in order to assist them in making informed treatment decisions .
In considering the Google review , the panel understood the member recognized his error in the post and had the information removed . Veterinarians are expected to maintain professionalism even in challenging situations .
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