Antimicrobial prescribing in dogs and cats with urinary tract disease in a prospective intervention trial

Background Veterinarians often cite the cost as a barrier to performing culture and susceptibility (C&S) testing. Hypothesis/Objectives To investigate the effects of fee-free C&S and to a decision support tool for urinary tract disease on antimicrobial prescribing behavior. Animals Twenty-one small animal general practice veterinary clinics in Melbourne, Australia were included in the study, 10 clinics in the intervention group and 11 clinics in the control group. Urine samples collected from dogs and cats were eligible. Methods A prospective cohort study was conducted in which clinics in the intervention group were provided access to free urine C&S for dogs and cats with clinical signs of urinary tract disease and a decision support tool. Clinical histories were analyzed for both groups to determine antimicrobial prescribing behavior. Results A total of 480 urine C&S submissions were received from the intervention group and 636 consultations for patients with urinary tract disease were included in the control group. Patients in the control group were more likely to empirically prescribe antimicrobials (P = .04). A higher proportion of cats in the control group received cefovecin (48%) compared with cats in the intervention group (22%, P = .03). Patients in the intervention group also were more likely to be prescribed empirical antimicrobial treatment for a shorter period of time than in the control group (P ≤ .001). Conclusions and clinical importance Removing the cost barrier to microbiological diagnostic testing and the provision of a decision support tool resulted in positive changes to antimicrobial prescribing behavior, particularly decreased prescribing frequency and shorter duration of antimicrobial treatment.