Ten-minute chat - studying appropriate antibiotic use in small animals
Sarah Caddy is a veterinary microbiology diplomat and clinician scientist at the University of Cambridge. She was recently awarded the first companion animal-based MSD Animal Health research bursary to study appropriate antibiotic use in small animals.
Tell us about the project
It’s a clinical trial that aims to determine whether antibiotics are necessary for healthy cats with draining cat bite abscesses. Many owners have told me that their cat had a draining abscess that got better on its own, but standard practice seems to be to give antibiotics regardless of clinical presentation. Trials in people suggest that antibiotics may not be needed for skin abscesses, so we want to investigate whether this is the same for cats.
Have you done anything similar before?
I examined antibiotic use in cases of haemorrhagic diarrhoea at a first-opinion practice where I work part time as an emergency clinician. I found that amoxycillin-clavulanate alone was just as effective as metronidazole and amoxycillin-clavulanate combined. I was keen to run this trial as during my PhD I looked at canine gastroenteritis viruses. Although I found two new dog viruses circulating in the UK –canine norovirus and canine astrovirus – my research didn’t change what vets should do in practice.
Why is it important to run trials in practice?
We are all aware that we should use fewer antibiotics, but pressure from clients and colleagues can be a challenge. Conducting randomised, blinded, controlled clinical trials can generate results that support future clinical decision making.
How do you find the time?
The trials are designed to be simple so very little extra work is needed in order to recruit cases. Planning was done in short periods over several months and updating the results database was done by showing up an hour early for a shift every now and again.
What has been the most difficult part?
Undoubtedly case recruitment. In a busy clinic it’s easy to forget that a case might be eligible for a trial. For my first trial I found myself doing more emergency shifts so that I could recruit more cases. An enthusiastic full-time vet could probably finish a clinical trial faster then I have.
Funding has also been a challenge so I am grateful to MSD Animal Health for its help with this; however, I’ve learnt it is possible to run a robust trial on a shoestring if practices are engaged.
What advice would you give anyone wanting to do something similar?
We need you! There are so many trials that could be run in first-opinion practice. Much of the treatment prescribed is based on very little evidence. Wouldn’t it be nice use trial results to explain to an owner why you didn’t prescribe antibiotics? I would also advise designing clinical trials very carefully before beginning any project.
There are now lots of places to get advice; I especially recommend the Journal of Small Animal Practice clinical research assessment and guidance panel.
What’s next in your research career?
Having juggled practice and research for the past seven years, I’ve finally made the decision to focus on my research work. I have just been awarded a Wellcome Trust clinical research career development fellowship that will allow me to start work on vaccine development. I plan to continue running first-opinion clinical trials alongside this main research project, and would love to hear from any practices that want to get involved. Sarah can be contacted here.