1. CDC. Antibiotic resistance threats in the United States. Available at: www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf, ed, 2013. Accessed Dec 14, 2018.
2. Klevens RM, Edwards JR, Richards CL Jr, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122:160–166.
3. Acar J, Rostel B. Antimicrobial resistance: an overview. Rev Sci Tech 2001;20:797–810.
4. Prescott JF, Boerlin P. Antimicrobial use in companion animals and Good Stewardship Practice. Vet Rec 2016;179:486–488.
5. Weese JS, Giguere S, Guardabassi L, et al. ACVIM consensus statement on therapeutic antimicrobial use in animals and antimicrobial resistance. J Vet Intern Med 2015;29:487–498.
6. Wayne A, McCarthy R, Lindenmayer J. Therapeutic antibiotic use patterns in dogs: observations from a veterinary teaching hospital. J Small Anim Pract 2011;52:310–318.
7. Escher M, Vanni M, Intorre L, et al. Use of antimicrobials in companion animal practice: a retrospective study in a veterinary teaching hospital in Italy. J Antimicrob Chemother 2011;66:920–927.
8. Mateus AL, Brodbelt DC, Barber N, et al. Qualitative study of factors associated with antimicrobial usage in seven small animal veterinary practices in the UK. Prev Vet Med 2014;117:68–78.
9. Adams VJ, Campbell JR, Waldner CL, et al. Evaluation of client compliance with short-term administration of antimicrobials to dogs. J Am Vet Med Assoc 2005;226:567–574.
10. Smith M, King C, Davis M, et al. Pet owner and vet interactions: exploring the drivers of AMR. Antimicrob Resist Infect Control 2018;7:46.
11. Henriksen K, Hansen EH. The threatened self: general practitioners’ self-perception in relation to prescribing medicine. Soc Sci Med 2004;59:47–55.
12. Szymczak JE, Feemster KA, Zaoutis TE, et al. Pediatrician perceptions of an outpatient antimicrobial stewardship intervention. Infect Control Hosp Epidemiol 2014;35(suppl 3):S69–S78.
13. Palinkas LA, Horwitz SM, Green CA, et al. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health 2015;42:533–544.
14. Guest G, Bunce A, Johnson L. How many interviews are enough?: an experiment with data saturation and variability. Field Methods 2006;18:59–82.
15. Grady MP. Qualitative and action research: a practitioner handbook. Bloomington, Ind: Phi Delta Kappa, 1998.
16. Weiss RS. Learning from strangers: the art and method of qualitative interview studies. New York: Free Press, 1994;61–81.
17. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277–1288.
18. Tesch R. Qualitative research: analysis types and software tools. Bristol, Pa: Falmer, 1990;115–141.
19. Miles M, Huberman A. Qualitative data analysis: an expanded sourcebook. 2nd ed. Thousand Oaks, Calif: Sage Publications, 1994;54–69.
20. Morse JM, Field PA. Qualitative research methods for health professionals. Thousand Oaks, Calif: Sage, 1995;21–31.
21. Liberatos P, Link BG, Kelsey JL. The measurement of social class in epidemiology. Epidemiol Rev 1988;10:87–121.
22. Society for Healthcare Epidemiology of America. Infectious Diseases Society of America, Pediatric Infectious Diseases Society. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol 2012;33:322–327.
23. Spurling GK, Del Mar CB, Dooley L, et al. Delayed antibiotic prescriptions for respiratory infections. Cochrane Database Syst Rev 2017;9:CD004417.
24. Coyne LA, Latham SM, Williams NJ, et al. Understanding the culture of antimicrobial prescribing in agriculture: a qualitative study of UK pig veterinary surgeons. J Antimicrob Chemother 2016;71:3300–3312.
25. De Briyne N, Atkinson J, Pokludova L, et al. Factors influencing antibiotic prescribing habits and use of sensitivity testing amongst veterinarians in Europe. Vet Rec 2013;173:475.
26. Currie K, King C, Nuttall T, et al. Expert consensus regarding drivers of antimicrobial stewardship in companion animal veterinary practice: a Delphi study. Vet Rec 2018;182:691.
27. Song SJ, Lauber C, Costello EK, et al. Cohabiting family members share microbiota with one another and with their dogs. eLife 2013;2:e00458.
28. van Duijkeren E, Wolfhagen MJ, Box AT, et al. Human-to-dog transmission of methicillin-resistant Staphylococcus aureus. Emerg Infect Dis 2004;10:2235–2237.
29. Cefai C, Ashurst S, Owens C. Human carriage of methicillin-resistant Staphylococcus aureus linked with pet dog. Lancet 1994;344:539–540.
30. van den Bogaard AE, Stobberingh EE. Epidemiology of resistance to antibiotics. Links between animals and humans. Int J Antimicrob Agents 2000;14:327–335.
31. Wegener HC, Aarestrup FM, Gerner-Smidt P, et al. Transfer of antibiotic resistant bacteria from animals to man. Acta Vet Scand Suppl 1999;92:51–57.
32. AVMA. Clinic posters: be careful with antibiotics, 2018. Available at: www.avma.org/PracticeManagement/ClientMaterials/Pages/clinic-posters-client-handouts.aspx. Accessed Dec 14, 2018.
33. Sabuncu E, David J, Bernede-Bauduin C, et al. Significant reduction of antibiotic use in the community after a nationwide campaign in France, 2002–2007. PLoS Med 2009;6:e1000084.
34. Goossens H, Guillemot D, Ferech M, et al. National campaigns to improve antibiotic use. Eur J Clin Pharmacol 2006;62:373–379.
35. Finkelstein JA, Davis RL, Dowell SF, et al. Reducing antibiotic use in children: a randomized trial in 12 practices. Pediatrics 2001;108:1–7.
36. Roope LSJ, Tonkin-Crine S, Butler CC, et al. Reducing demand for antibiotic prescriptions: evidence from an online survey of the general public on the interaction between preferences, beliefs and information, United Kingdom, 2015. Euro Surveill 2018;23:1700424.
37. Nyhan B, Reifler J, Richey S, et al. Effective messages in vaccine promotion: a randomized trial. Pediatrics 2014;133:e835–e842.
38. Stivers T, Mangione-Smith R, Elliott MN, et al. Why do physicians think parents expect antibiotics? What parents report vs what physicians believe. J Fam Pract 2003;52:140–148.
39. Aenishaenslin C, Ravel A, Michel P, et al. From Lyme disease emergence to endemicity: a cross sectional comparative study of risk perceptions in different populations. BMC Public Health 2014;14:1298.
40. Littman MP, Gerber B, Goldstein RE, et al. ACVIM consensus update on Lyme borreliosis in dogs and cats. J Vet Intern Med 2018;32:887–903.
41. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006;43:1089–1134.
42. Dellit TH, Owens RC, McGowan JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159–177.
43. Morency-Potvin P, Schwartz DN, Weinstein RA. Antimicrobial stewardship: how the microbiology laboratory can right the ship. Clin Microbiol Rev 2016;30:381–407.
44. Murphy CP, Reid-Smith RJ, Boerlin P, et al. Out-patient antimicrobial drug use in dogs and cats for new disease events from community companion animal practices in Ontario. Can Vet J 2012;53:291–298.
45. AVMA Task Force for Antimicrobial Stewardship in Companion Animal Practice. Understanding companion animal practitioners’ attitudes toward antimicrobial stewardship. J Am Vet Med Assoc 2015;247:883–884.
46. Fowler H, Davis MA, Perkins A, et al. A survey of veterinary antimicrobial prescribing practices, Washington State 2015. Vet Rec 2016;179:651.
47. Page S, Prescott J, Weese S. The 5Rs approach to antimicrobial stewardship. Vet Rec 2014;175:207–208.
48. AVMA. Antimicrobial stewardship definition and core principles, 2018. Available at: www.avma.org/KB/Policies/Pages/Antimicrobial-Stewardship-Definition-and-Core-Principles.aspx. Accessed Dec 14, 2018.
49. AVMA. Antimicrobials: guidelines for judicious use, 2017. www.avma.org/KB/Resources/Reference/Pages/Antimicrobial-use.aspx. Accessed Dec 14, 2018.
50. Lappin MR, Blondeau J, Boothe D, et al. Antimicrobial use guidelines for treatment of respiratory tract disease in dogs and cats: Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases. J Vet Intern Med 2017;31:279–294.
51. Burmeister E, Aitken LM. Sample size: how many is enough? Aust Crit Care 2012;25:271–274.
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OBJECTIVE To explore owners’ knowledge of and experiences with antimicrobial treatment of their pets and their perceptions of veterinarian-led antimicrobial stewardship initiatives.
DESIGN Cross-sectional study.
SAMPLE 25 pet owners visiting 1 of 3 clinic types (tertiary care, general practice, or low cost) in the greater Philadelphia area.
PROCEDURES Semistructured interviews were conducted with pet owners to gather responses related to the study objectives. Responses were transcribed and analyzed by means of conventional content analysis.
RESULTS Although participants were mostly unfamiliar with the mechanisms of antimicrobials and antimicrobial resistance, they generally understood what constituted the inappropriate use of antimicrobials. Few pet owners appeared concerned about the risk of antimicrobial resistance, and no owners were concerned that antimicrobials used for people were also used for pets. Overall, pet owners reported closely following veterinarians’ directions when administering antimicrobials at home, and the main reasons for not following directions included difficulty administering the medication and concern about overmedicating the pet. Most (21/25 [84%]) pet owners expressed trust in their veterinarian to meet their pets’ medical needs and prescribe antimicrobials appropriately. However, in situations when it was unclear whether antimicrobials would be effective, most owners nevertheless wanted their pet to receive them. Initiatives to promote the judicious use of antimicrobials, such as microbial culture and antimicrobial susceptibility testing and formal stewardship programs, were generally well received and appreciated by owners.
CONCLUSIONS AND CLINICAL RELEVANCE Considerable opportunity was identified to leverage the trust that exists between veterinarians and pet owners to promote the judicious use of antimicrobials for pets.