Prospective trial of different antimicrobial treatment durations for presumptive canine urinary tract infections

BMC Veterinary Research

Andria Cauvin¹  Sarah Caddy²  James Swann³  Julien Bazelle⁴  Koen B. Pouwels⁵  Luisa De Risio⁶  James Warland⁷  Fergus Allerton⁸  Andrew Kent⁸ 

[1] Beechley Farm, Park Hall Road, Gosfield, Essex, UK;Cambridge Institute for Therapeutic Immunology and Infectious Disease, Jeffery Cheah Biomedical Centre, Puddicomb Way, Cambridge Biomedical Campus, Cambridge, UK;Columbia Stem Cell Initiative, Columbia University, 650 West 168th Street, 10032, New York, NY, USA;Davies Veterinary Specialists; part of Linnaeus Veterinary Limited, Manor Farm Business Park, Higham Gobion, Hitchin, UK;Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK;NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial, Oxford, UK;Resistance at University of Oxford in partnership with Public Health England, Oxford, UK;Linnaeus Veterinary Limited, Friars gate, Shirley, Solihull, UK;Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, University of Cambridge, Puddicombe Way, Cambridge, UK;Willows Veterinary Centre and Referral Service; part of Linnaeus Veterinary Limited, Highlands Road, Shirley, Solihull, UK;

关键词: Antimicrobial stewardship;    Antimicrobial resistance;    duration;    Urinary tract infection;    Canine;    Duration-response curve;   

DOI  :  10.1186/s12917-021-02974-y

来源: Springer

【 摘 要 】

BackgroundAvoidance of unnecessary antimicrobial administration is a key tenet of antimicrobial stewardship; knowing the optimal duration of therapy obviates over-treatment. However, little research has been performed to establish course lengths for common canine infections. In clinical practice, antimicrobial therapy is frequently prescribed in dogs presenting lower urinary tract signs (haematuria, pollakiuria and dysuria/stranguria). The proposed length of treatment in International Consensus guidelines has decreased with each iteration, but these recommendations remain arbitrary and largely extrapolated from experience in people.MethodsThe objective of this prospective, multi-centre study is to find the shortest course duration that is non-inferior to the standard duration of 7 days of amoxicillin/clavulanate in terms of clinical outcomes for female dogs with lower urinary tract signs consistent with a urinary tract infection. An electronic data capture platform will be used by participating veterinarians working in clinical practice in the United Kingdom. Eligible dogs must be female, aged between 6 months and 10 years and have lower urinary tract signs of up to seven days’ duration. Enrolment will be offered in cases where the case clinician intends to prescribe antimicrobial therapy. Automatic pseudo-randomisation to treatment group will be based on the day of presentation (Monday-Friday); all antimicrobial courses will be completed on the Sunday after presentation generating different treatment durations. Follow-up data will be collected 1, 8 and 22–26 days after completion of the antimicrobial course to ensure effective safety netting, and to monitor short-term outcome and recurrence rates. Informed owner consent will be obtained in all cases. The study is approved by the Ethical Review Board of the University of Nottingham and has an Animal Test Certificate from the Veterinary Medicine’s Directorate.DiscussionThis study has been designed to mirror current standards of clinical management; conclusions should therefore, be widely applicable and guide practising veterinarians in their antimicrobial decision-making process. A duration-response curve will be created allowing determination of the optimal treatment duration for the management of female dogs with lower urinary tract signs. It is hoped that these results will contribute valuable information to improve future antimicrobial stewardship as part of a wider one-health perspective.

【 授权许可】

CC BY