Use antibiotics only when needed – Antimicrobial resistance also affects pets

Reducing the overall use of antibiotics is the only sustainable solution to antibiotic resistance. This can be done by improving practices in every specialist field, including pet care.

Here's a typical situation at the veterinarian's office: a dog suffering from persistent cough is examined, the options are weighed and, in the end, a course of antibiotics is prescribed, just in case. Such individual instances converge into the overuse of antibiotics which also contributes to the increase in antibiotic resistance.

Resistance to antibiotics, or bacteria that are resistant to antibiotics, is a problem that has rapidly grown and diversified in recent years all across the globe. Several factors contribute to antibiotic resistance, and the problem threatens both human and animal health – already now, more than five million people die because of antibiotic resistance each year. At its worst, resistance to antibiotics can compromise the foundation of our most conventional medical therapies and procedures.

This major problem is being solved piece by piece. The piece on which Sanna Viitanen, a veterinarian specialised in pulmonary diseases, focuses is the development of diagnostics for the lung diseases of small animals.

“These days, the medication of small animals, such as cats and dogs, is advanced and similar to that of humans. They can even be cared for in hospitals, and the diseases are partly the same too. The overuse of antibiotics and antibiotic resistance also apply to pets,” Viitanen explains the background of the phenomenon.

In pets, antibiotics are typically used for, among other ailments, urinary tract infections, skin infections and pulmonary diseases, just like in humans. In the case of bronchitis caused by bacteria, antibiotics are definitely needed, but what about problems of an entirely different kind? Chronic cough, shortness of breath and other symptoms of many pulmonary diseases are very similar.

“If all coughing dogs are given antibiotics on the basis of exclusion, perhaps only one in 10 courses would have actually been necessary,” Viitanen notes.

When are antibiotics needed?

Viitanen wants to determine how to reliably identify the need for antibiotics at the veterinarian’s office. In autumn 2021, she was awarded a four-year clinical researcher grant by the Academy of Finland, which now enables her to focus on research alongside her clinical practice.

Viitanen is looking for novel biomarkers, or markers to be measured in blood or urine samples for the diagnosis of various pulmonary diseases. One potential canine biomarker is C-reactive protein (CRP), which is an infection marker also in humans, while cats have their own in the form of serum amyloid A (SAA). Other options will be determined through research.

To be able to carry out diagnostics even at smaller veterinary clinics, rapid diagnoses using, for example, a blood sample are needed.

“The only way to definitively diagnose bacterial bronchitis is a bronchoscopy and bronchoalveolar lavage and a bacterial culture. It’s expensive, and the equipment and skills needed are not available everywhere in Finland. Moreover, the animal must be anaesthetised for the procedure, which can bring about additional risks, especially for older and seriously ill patients,” says Viitanen.

What about cats and dogs?

The consumption of antibiotics by pets and antibiotic resistance have a direct effect on people living in the same household with the animals. Animals can carry resistant bacteria, which can also be transmitted to humans.

Dogs that are administered repeated antibiotic courses over a longer period can carry resistant bacteria. One element of Viitanen’s research focuses on Irish Wolfhounds with recurring pneumonias, of whom as many as one-third carry bacteria resistant to antibiotics.

Usually, dogs may carry multi-resistant bacteria for some time, for example, after repeated antibiotic courses, until their own bacterial flora eventually returns to normal. The same phenomenon has also been observed in travellers returning from abroad – for example, from India – bringing a superbug back with them. While bacteria may not be particularly aggressive in their pathogenicity, the situation can become serious if they end up in, for example, a surgical wound or implant.

Viitanen's research includes cat patients, and the goal is to identify effective methods for detecting feline asthma in particular.

“It appears that cats have naturally fewer multi-resistant strains, but more research on this is needed,” Viitanen says.

Change starts at the vet's office

The enormous whole of antibiotic resistance is solved one patient at a time, from the grassroots up. According to Viitanen, change starts at the vet’s office.

“Veterinarians must be provided with tools and means at their practice to help them ascertain the genuine need for antibiotic medication in order to prevent the prescription of unnecessary antibiotics.”

Viitanen believes that the use of antibiotics could be reduced also through the continuing education of veterinarians and shared up-to-date information on the use of antibiotics with animal owners. Treatment practices have changed over the years. For example, antibiotics are no longer recommended, as a rule, for the treatment of acute diarrhoea.

Internationally, a substantial amount of related research is ongoing in various fields, and expert panels make recommendations on the use of antibiotics in different diseases. According to Viitanen, recommendations are continuously being updated in an increasingly conservative direction, with the aim of discontinuing all treatments where antibiotics are given ‘just to be on the safe side’. Research serves as a basis for these recommendations. For instance, studies carried out in recent years at the Veterinary Teaching Hospital have laid the groundwork for determining the duration of antibiotic therapies for canine pneumonia in the latest international recommendations.

Sanna Viitanen is pleased with the opportunity to focus on her research with the support of the Academy of Finland. The state-of-the-art infrastructure of the Veterinary Teaching Hospital makes it possible to conduct clinical research.

“My research motivates me in clinical work, and it is an opportunity to change the world – one small piece at a time!”

What can pet owners do?
  • Trust in the expertise of your veterinarian. Do not insist on medication just in case, and do not resort to self-medication. Keep in mind that pets have to take their antibiotics as prescribed, just like humans.
  • Be patient. Recurring problems or prolonged symptoms require investigation and effort. Recurring infections can be caused by a predisposing factor whose determination may be difficult. Often, you should start looking into the underlying cause, not just treat symptoms with Recurrent antibiotic courses  of antibiotics. In the long run, this can also be more cost-efficient, even if a single course would be less expensive than, for example, a pricier endoscopy.
  • Underlying diseases must be treated first. For example, there may be structural problems in the urinary tract that can be surgically fixed. Atopy and skin symptoms can result in ear infections and continuous unnecessary antibiotic courses.
  • Often, antibiotics alone are not enough, but supportive therapies, such as cleaning the infected area or protecting it from being licked, are also needed. These are just as important for the animal’s recovery as antibiotics.
  • Pets share the same environment with us, and high-quality indoor air is important to them as well. Further research is needed on the effects of indoor air on pets’ pulmonary diseases, but they may be similar to those seen in humans.

Source: Sanna Viitanen, DVM, and Finnish Food Authority

FINRES-Vet monitors resistance to antibiotics among animals in Finland

Since 2002, a programme for monitoring antibiotic resistance called FINRES-Vet has been ongoing in Finland. The programme investigates the susceptibility to antibiotics of pathogenic bacteria that are transmitted between animals and humans, that is, zoonotic bacteria, as well as of animal pathogens and indicator bacteria.

Alongside the resistance situation, the programme monitors the use of feed additives and the consumption of therapeutic antibiotics for animals. In addition to the Finnish Food Authority, the FINRES-Vet programme is implemented by the Finnish Medicines Agency Fimea and the University of Helsinki’s Faculty of Veterinary Medicine. Since 2012, resistance data on companion and hobby animals have been collected at the Laboratory of Clinical Microbiology of the Faculty of Veterinary Medicine.

The results of the FINRES-Vet programme are compiled in summaries published at regular intervals. The reports are available on the website of the Finnish Food Authority.

For the time being, monitoring the sale of antibiotics for companion animals is only possible for tablets. The sale of antibiotic tablets for companion animals has continued to decrease and has halved over 10 years.

In Finland, the sale of antibiotics in proportion to the number of production animals remains extremely moderate. In 2020, sales were lower than ever before.