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18 VET REPORT VITALS VET REPORT VITALS review of the medical notes from a random sample of 500 UTI episodes: 250 for which amoxicillin was dispensed and 250 for which amoxicillin– clavulanate was dispensed. For amoxicillin, 34% of the reviewed prescriptions were concordant with the ISCAID recommended dosage and 14% were concordant with both the recommended frequency and duration. For amoxicillin–clavulanate, 78% of reviewed prescriptions were concordant with the recommended dosage, <1% with the recommended frequency, and 28% with the recommended duration. Antimicrobial Use in Respiratory Tract Infections There were 24,402 episodes of guideline-related canine respiratory disease treated with a single antimicrobial at Banfield Pet Hospitals in 2015, 95% of which were classified as canine infectious respiratory disease complex (CIRD) and 5% as bacterial bronchitis ( Table 2 ). Fifteen of 17 reviewers in ISCAID's recently published guidelines for treatment of RTI recommended first- line treatment of the bacterial component of CIRD with doxycycline (5 mg/kg PO q12h or 10 mg/kg PO q24h) for a duration of 7 to 10 days. 5 Amoxicillin– clavulanate (11 mg/kg PO q12h) was considered a suitable alternative by 13 of 17 reviewers. For bacterial bronchitis, doxycycline (5 mg/kg PO q12h or 10 mg/kg PO q24h) was recommended by 16 of 17 reviewers as the preferred empirical choice while waiting for results of C&S; testing. Based on these criteria, 25% of CIRD episodes were treated with a guideline-concordant antimicrobial—increasing to 80% if amoxicillin–clavulanate is considered a suitable alternative—while 22% of bronchitis episodes received a guideline-concordant drug. AWARENESS AMONG VETERINARIANS CAN BE INCREASED PRESCRIPTION PATTERNS CAN BE IMPROVED are concerned about antimicrobial-resistant infections 2 In 2015, guideline-recommended first-line antimicrobials were not prescribed for 6 : 32.9 % of canine nonrecurrent urinary infections 55.8 % of canine recurrent urinary infections 78.3 % of canine bronchitis episodes feel that antimicrobials in small animal practice impact AMR 2 are unaware of the 3 existing sets of antimicrobial use guidelines: urinary infections, 3 superficial bacterial folliculitis, 4 and respiratory infections 5 45% 62% 88% of canine infectious respiratory disease episodes 20.4 % TABLE 2 Concordance With Dosage, Frequency, and Duration Guidelines for Treatment of UTIs and RTIs NUMBER OF RECORDS REVIEWED RECOMMENDED DOSAGE GIVEN RECOMMENDED FREQUENCY GIVEN RECOMMENDED DURATION GIVEN UTIs Amoxicillin 250 85/250 (34%) 34/250 (14%) 34/250 (14%) Amoxicillin–clavulanate 250 194/250 (78%) 1/250 (<1%) 69/250 (28%) RTIs Doxycycline 250 72/250 (29%) 250/250 (100%) 115/250 (46%) Amoxicillin–clavulanate 250 14/250 (6%) 250/250 (100%) 128/250 (51%) FIGURE 1. Data about AMR awareness and antimicrobial use in veterinary medicine.