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17 MAY/JUNE 2017 ■ TVPJOURNAL.COM VET REPORT VITALS TABLE 1 Concordance With Drug Guidelines for Treatment of UTIs and RTIs NUMBER OF EPISODES CONCORDANCE NOT INCLUDING AMOXICILLIN–CLAVULANATE CONCORDANCE INCLUDING AMOXICILLIN–CLAVULANATE UTIs Recurrent 23,561 (95%) 2120 (9%) 15,786 (67%) Nonrecurrent 1240 (5%) 87 (7%) 546 (44%) RTIs CIRD 23,182 (95%) 5796 (25%) 18,546 (80%) Bacterial bronchitis 122 (5%) 29 (22%) n/a CONCORDANCE OF CURRENT USAGE PATTERNS WITH GUIDELINE RECOMMENDATIONS The availability of population-based data on antimicrobial use in companion animals from the electronic medical records of Banfield Pet Hospital provides an excellent snapshot of current usage patterns in general practice. This year's edition of the VET Report™ explored antimicrobial usage patterns among companion animal practitioners to help inform voluntary adjustments that could result in a better balance between patient care and public health. Methodology The report looked at antimicrobial usage patterns from the electronic medical records of dogs evaluated for urinary tract infections (UTIs) or respiratory tract infections (RTIs) at any of 926 general-practice Banfield Pet Hospitals over the course of a calendar year (January 1, 2015–December 31, 2015). Usage patterns were evaluated for concordance with recommendations for antimicrobial treatment (drug, dosage, frequency, and duration) of UTIs and RTIs published by the Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases (ISCAID). 3,5 Because the primary aim was to evaluate concordance with current first-line treatment guidelines, only episodes in which a single antimicrobial was dispensed were included in the analysis. Antimicrobial Use in Urinary Tract Infections There were 24,801 episodes of canine UTI treated with a single antimicrobial at Banfield Pet Hospitals in 2015 ( Table 1 ). Episodes were further classified as recurrent or nonrecurrent based on whether the patient had experienced 2 or more UTIs in the preceding 12 months. Of the 24,801 episodes evaluated, 95% were determined to be nonrecurrent in nature, whereas 5% were preceded by 2 or more UTIs in the previous year. The most recently published guidelines for care of nonrecurrent UTIs recommend initial treatment with amoxicillin (11–15 mg/kg PO q8h) or trimethoprim–sulfonamide (15 mg/kg PO q12h) for a duration of 7 days. 3 Amoxicillin– clavulanate (12.5–25 mg/kg PO q8h) is described as an acceptable option, but not recommended owing to lack of evidence of the need for clavulanic acid. Based on these criteria, 9% of nonrecurrent UTI episodes received a guideline-concordant antimicrobial, although that number increases to 67% if amoxicillin– clavulanate is considered an acceptable option. For recurrent UTIs, guidelines recommend that providers consider waiting for culture and susceptibility (C&S;) results before instituting therapy. In cases where immediate treatment is warranted, the same recommendations as for nonrecurrent UTIs apply, with the additional recommendations that antimicrobial therapy be given for a duration of 4 weeks and that an alternative drug class to the one used for treatment of the previous UTI be dispensed. For recurrent infections, 7% of episodes received a guideline-concordant drug, increasing to 44% if amoxicillin–clavulanate is considered concordant. Information about dosage, frequency, and duration was unavailable as structured data, so a utilization snapshot was obtained by conducting a manual