AMR Hub

In our AMR Hub, you will find freely accessible, evidence-based knowledge and resources about responsible antimicrobial use. With over 42 hours of CPD, teams can access this information and embed good antimicrobial stewardship in practice.

If you would like to speak with us about our AMR work, or to suggest materials for inclusion on this page, please get in touch at ebvm@rcvsknowledge.org

Latest resources

• Responsible use of antibiotics in veterinary practice - This RCVS Knowledge collection provides access to evidence and appropriate resources to support responsible antibiotic use. 
• Farm Vet Champions has over 20 hours of free CPD covering species-specific antimicrobial use, communication skills, behaviour change and the legal use of medicines, policies and One Health.
• UK 5-year action plan for antimicrobial resistance 2019 to 2024 - Ambitions and actions for the next 5 years, supporting the 20-year vision for antimicrobial resistance (AMR).
• Research Focus - STOP on Sunday (SOS) Urinary Tract Infection Trial - In this RCVS Knowledge podcast, Fergus Allerton spoke to Sally Everitt about the SAMSoc 'STOP on Sunday (SOS) Urinary Tract Infection Trial', which is recruiting first opinion practice vets.

1. Governance on antimicrobial resistance

• UK 5-year action plan for antimicrobial resistance 2019 to 2024 - Ambitions and actions for the next 5 years, supporting the 20-year vision for antimicrobial resistance (AMR).
• UK 20-year vision for antimicrobial resistance. This document supports the 20-year vision for antimicrobial resistance (AMR) and how the UK will contribute to containing and controlling antimicrobial resistance by 2040.

• UK Chief Veterinary Officer Christine Middlemiss chaired a roundtable discussion in 2019 on challenges presented by antimicrobial resistance and ways to tackle it [podcast], with guests Ian Battersby (Davies Veterinary Specialists/Mission Rabies), Steve Howard (PDSA), Kristen Reyher (Bristol Veterinary School) and David Singleton (Small Animal Veterinary Surveillance Network). 
• Veterinary Antimicrobial Resistance and Sales Surveillance 2020 (UK VARSS) - This report provides the details of UK veterinary antibiotic resistance and sales surveillance.

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2. Biosecurity and infection control

This webinar series provides guidance on different aspects of infection control. Aimed at veterinary professionals, the series will help you to improve your infection control and biosecurity practices, helping you instigate responsible antimicrobial use. The series contains five webinars that cover:

1. Biosecurity during COVID-19: Recorded during the COVID-19 pandemic, but introduces biosecurity as a whole to get your team thinking about how this relates to practice (CPD: 60 minutes).
2. Organisms of concern and modes of transmission: Understanding modes of transport for different organisms can help your team put processes in place to help prevent disease. This webinar will set the foundations for understating infections within the practice – essential for effective infection control and patient care (CPD: 60 minutes). 
3. Policies and procedures in routine practice: The patient’s journey through practice can cover numerous areas, so how can you protect patients, clients, and the team? Providing practical guidance on implementing infection control policies and procedures within the practice, the role of infection prevention will be covered, including creating an infection control group within the practice; how to develop a biosecurity policy; and areas in practice that need consideration (CPD: 70 minutes).
4. Disinfectant types: Including relevant terminology, the action of disinfectant, active ingredients and how to choose the most appropriate one. This webinar is ideal for everyone working in practice, and a must for anyone producing or updating infection control procedures (CPD: 30 minutes). 
5. Auditing in veterinary practice: Once you have your infection control guidelines in place, how do you know if they are helping to improve your patient, client, and practice team’s safety? Auditing infection control will help you understand how an audit can be useful in infection control with examples on how to audit your cleaning protocols, hand hygiene and post-operative complications (CPD: 60 minutes).

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3. Current guidelines on antimicrobial stewardship

• Farm Vet Champions has over 20 hours of free CPD covering species-specific antimicrobial use, communication skills, behaviour change and the legal use of medicines, policies and One Health.
• BSAVA PROTECT ME - BSAVA and SAMSoc have worked together to provide information that is intended to support practices in discussing and drawing up practice guidelines on responsible antibacterial use.
• BSAVA guidelines for responsible antibacterial use - Following these BSAVA guidelines will help to maximise the therapeutic success of antibacterial agents whilst at the same time minimising the development of antibacterial resistance, thereby safeguarding antimicrobials for future veterinary and human use. 
• BEVA Protect Me Toolkit - Guidelines on responsible antimicrobial use in equines.
• Responsible Use of Medicines in Agriculture (RUMA) Alliance - RUMA guidelines for responsible antimicrobial use in food-producing animal species.

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4. Evidence from research

Find below the available research regarding antibiotic use within practice and published Knowledge Summaries from Veterinary Evidence. These talk about antimicrobial usage, but not necessarily a reduction in usage. However, the evidence may help you to use antibiotics more responsibly in practice.

• in the Spotlight

1. Responsible use of antibiotics in veterinary practice - This RCVS Knowledge collection provides access to evidence and appropriate resources to support responsible antibiotic use. 

• inFOCUS journal watch: 

1. Randomised positive control trial of NSAID and antimicrobial treatment for calf fever caused by pneumonia - This summarises evidence that shows that in some cases the use of NSAIDs can reduce the requirement for antimicrobials in calves with pneumonia and improve clinical outcomes. 

2. Ceasing the use of the highest priority critically important antimicrobials does not adversely affect production, health or welfare parameters on dairy cows - This study summarises evidence that shows that discontinuing the use of Highest Priority Critically Important Antimicrobials did not have a negative effect on the productivity parameters or health and welfare of dairy cows.

• Veterinary Evidence: 

1. This Knowledge Summary explores antibiotic choices for the best treatment outcomes for Chlamydophila Felis infection in cats. 

2. This Knowledge Summary explores the outcomes from the use of antibiotics in bitches with pyometra as a standalone therapy or when combined with ovariohysterectomy. 

3. This Knowledge Summary summarises the evidence on pregnancy rate outcomes for post-service treatment with or without antibiotics for broodmares with endometritis. 

4. This Knowledge Summary summarises the evidence to support the duration of antibiotic treatment for placentitis in mares and reflects on the outcomes on foal viability. 

5. This Knowledge Summary explores whether outcomes were better from antibiotic or non-antibiotic topical treatment for digital dermatitis in dairy cattle. 

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5. Farm Vet Champions podcasts

• Farm Vet Champions has over 20 hours of free CPD covering species-specific antimicrobial use, communication skills, behaviour change and the legal use of medicines, policies and One Health.
• BCVA Cattlecast [podcast] on how farm vet practices can engage with the Farm Vet Champions project.
• The Steward - Animal health [podcast] explores antimicrobial stewardship and the role that the Farm Vet Champions project plays in championing responsible antimicrobial use behaviours.

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6. VetTeamAMR - championing responsible antimicrobial use 

VetTeamAMR aims to reduce the development and spread of antimicrobial resistance through championing responsible antimicrobial use practices. VetTeamAMR is a major collaborative project to unite and empower companion, farm and equine veterinary teams in responsible antimicrobial stewardship.

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7. Clinical case examples from practices

These case examples are from practices that have either reduced and refined their antimicrobial use or audited and improved their infection control and biosecurity. These examples will show you how individual practices have worked and inspire you to assess your own protocols.

• Plymouth Veterinary Group created guidelines for performing cytology on patients presenting with ear pathology, utilising the whole teams' skillset and reducing the overall prescription of antibiotics.
• Meghan Conroy performed a process audit on aural cytology, before and after treatment for otitis was given. By introducing training, the team were able to improve their prescribing practices across their branch practices. You can listen to Meghan discuss her case example in a podcast.
• Kay Lockwood, from Riversbrook Veterinary Group, performed a process and an outcome audit to monitor the use of antibiotics during feline dental extractions. 
• The Blue Cross developed guidelines within the practice to deliver a consistent approach to diagnosis and treatment throughout the charity for more than 60 common syndromes and conditions. 
• The Laurels used an audit to monitor hand hygiene and compliance to uniform protocols, to keep on top of their infection control in practice. 
• Vale Vets performed a hygiene audit through self-assessment to maintain a just culture and to identify any at-risk areas and further training required. 
• Vets Now Referrals Glasgow assessed their hand hygiene by completing a clinical audit that assessed adherence to WHO handwashing. 
• After incidences of phlebitis, one practice implemented a peripheral catheter care checklist and monitored its use and effectiveness through clinical audit.
• This peripheral catheter care and phlebitis score checklist has been designed in collaboration with Sarah Hancill RVN and Anne Ward PGCertTLHE DipAVN(Surgical) RVN. The template can be used in practice and adapted to suit your own practice protocols. 
• After a bulk tank failure after a case of mastitis, the QI Vets team perform a Significant Event Audit to identify what happened.

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8. Tools and recommendations

• Our antibiotic usage self-assessment checklist is adapted from the Public Health England and the Royal College of General Practitioners, and help vets to better understand their antibiotic usage. 
• SAVSNET is a surveillance tool for companion animals run by the University of Liverpool that harnesses electronic health and environmental data for rapid and actionable research and surveillance. This includes a specific project on antimicrobial resistance called mySAVSNET AMR, which is aimed at all those working in veterinary practice in the UK. It allows any practices to send data to researchers at the University of Liverpool to receive a free benchmark, comparing their antibiotic prescriptions to other anonymised practices across the country.
• VetCompass is an initiative focused on improving companion animal health run by the Royal Veterinary College. VetCompass are investigating the range and frequency of companion animal health problems through computerised practice records including AMR as a major research focus. 
• The Bella Moss Foundation is a non-profit charity that promotes prudent antimicrobial use and hygiene in human and veterinary medicine. On the website, you will find links to key veterinary bodies and guidelines concerning diagnosing and managing bacterial infections and AMR.

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