Organisation

Arwain DGC

Arwain DGC: Providing and Communicating Horse Health Clinics in Wales to avoid unnecessary use of antibiotics

Project Overview

Arwain DGC is a project created to highlight the issue of antimicrobial resistance (AMR) and to help farmers, horse owners and vets in Wales reduce the need to use antibiotics, through the use of training, technology, data gathering, and intelligence.

As companion animals, a unique aspect related to antimicrobial resistance in horses is their close contact with humans providing opportunities for interspecies transmission of (multidrug) resistant bacteria. According to a recent study by Isgren et al (2019), there is evidence to suggest that AMR is already happening in horses. Additionally, the indiscriminate use of critically important antibiotics in horses and other animals has rendered them ineffective in some human infection.

The aim of the Arwain DGC Equine Health Clinics run by Menter a Busnes, one of the project partners, is to communicate with the equine community and their veterinary support in Wales to address and increase their knowledge of AMR in horses. The Equine Health Clinics provide an opportunity for all horse owners in Wales to access one-to-one advice and screening from their local vet to help prevent illness and avoid unnecessary exposure to antimicrobials. Discussions focus on horses’ health and preventative measures horse owners can take to ensure their horses stay healthy, reducing the risk of antimicrobial resistance.

The support available to help protect horses and minimise the risk of AMR include:
i) Advice on biosecurity;
ii) Advice on health planning;
(iii) General health advice and check-up;
(iv) Bacterial culture and sensitivity testing (if required, following a clinical assessment by the horse owners’ local vet).

Aberystwyth University, another Arwain DGC project partner, is working on gathering data to better understand patterns of AMU in the equine industry.

Impact on tackling AMR

1. Developing a pan-Wales communication strategy to support equine and mixed vets in Wales to reduce AMR in horses
• 48 vets in Wales attended a webinar on ‘Equine Health – Antimicrobial Stewardship & Biosecurity in Wales’ as part of launching the Equine Health Clinics in Jan 2022.
• A resource Booklet and Video has been created for vets on the Equine Health Clinics.
• Numerous social media posts created to encourage engagement, reaching 91,564 people from our targeted audience over a 60-day period.
• Ongoing case studies to continue dissemination of results.
2. 2. Establishing a pan-Wales communication strategy to support the equine community in Wales to reduce AMR in horses
• A video was created during World Antimicrobial Awareness Week 2021 to raise awareness of AMR in horses.
• In Feb 2022, the Equine Health Clinics were launched to the equine community in Wales on social media: Facebook (reaching over 12,000 people), Twitter and Instagram.
• Over 400 people across Wales have engaged with these posts, sharing and reacting to the information provided.
• A flyer was published and a Press Notice was released to help promote the Equine Health Clinics.
3. Feedback from vets and horse owners have ensured that the support available is relevant and useful
• 120 Equine Health Clinic Reports received from vets with positive comments and useful information about AMR.
• Bacterial culture and antimicrobial susceptibility testing has resulted in the appropriate use of antimicrobials only when required.
• 41 positive feedback forms from horse owners received, confirming the support through the Equine Health Clinics have been invaluable.
• 100% of horse owners noted that they thought the clinics were either very useful (5/5) or useful (4/5), and 73% have made changes to improve the health of their horses following advice from their vet during the Equine Health Clinic.

Future Development

• Continuation of the Equine Health Clinics in Wales to achieve the target of 200 completed clinics by June 2023 and to reduce unnecessary use of antibiotics in horses.
• Further promotion of the scheme will continue at vet client evenings and shows, and to younger audiences such as colleges and pony clubs.
• A series of short videos on various equine health topics will be created following suggestions by horse owners in the Equine Health Clinic Feedback Forms.
• A programme of promotional activities and events will be created for World Antimicrobial Awareness Week (WAAW) 2022, which will include a mixture of videos, case studies and webinars as well as development of the programme created during WAAW 2021.

Organisation

FDI World Dental Federation

Engaging the global dental profession to help tackle antibiotic resistance

Project Overview

‘Rotten teeth are rarely life-threatening, thanks to antibiotics,’ (The Guardian, May 2022). In the pre-antibiotic era, however, death from oral and dental infections were common. Dentists are responsible for around 10% of antibiotic prescribing across human healthcare globally.

During 2020, dental antibiotic prescribing increased dramatically due to COVID-19 pandemic restrictions on dental procedures to prevent and manage dental infections. In response, FDI World Dental Federation published a framework about the essential role of dental teams in tackling antibiotic resistance (www.fdiworlddental.org/resource/fdi-white-paper-essential-role-dental-team-reducing-antibiotic-resistance). Aligned to the World Health Organization (WHO) Global Action Plan objectives, its recommendations help to raise awareness, prevent infections, and optimise the use of antibiotics in dentistry, including by building capacity of the global research base for dental antibiotic prescribing, resistance and stewardship. To accompany its launch, an online library of resources which can be tailored to the local context was published (https://fdiforum.bsac.org.uk/), along with an open online course.

FDI is the main representative body for more than one million dentists worldwide. Its membership comprises some 200 national member associations and specialist groups in over 130 countries. In addition to the exemplar projects described in the following sections, FDI continues to engage and communicate about dental antibiotics globally, including through professional webinars , courses and conferences as well as with the wider public through media releases (e.g.www.fdiworlddental.org/prescribing-dental-antibiotics-22-england-during-first-year-covid-19) and online videos (e.g.www.youtube.com/watch?v=mf-KfiOJ9VQ) via World Dental Congress, AMR Youth Summit, International Association for Dental Research and FDI’s digital Oral Health Campus.

For this application, we have selected three exemplars to demonstrate the impact so far of FDI’s framework and how it has been embedded across the dental community globally: at clinical (dental team and patient) level, through dental organisations, and with academia. These include a massive open online course, a pledge for national dental organisations, and a network for early career researchers.

Impact on tackling AMR

1. Engaging with individuals
Accompanying the FDI white paper is a massive open online course developed collaboratively with Future Learn and British Society for Antimicrobial Chemotherapy (www.futurelearn.com/courses/tackling-antibiotic-resistance-dentists). Since its launch during World Antimicrobial Awareness Week (WAAW) 2020, >2200 learners have enrolled from >100 countries, including >61 Global South countries. Designed to provide something for everyone whilst recognising the breadth of experience and differences in local contexts, FDI is thrilled with the course’s popularity among dental students (from Afghanistan, Bolivia, Mongolia and many more countries), aspiring dental students and the wider public.

2. Commitment of national organisations
FDI’s white paper encourages national dental associations (NDAs) and other organisations to commit to tackling antibiotic resistance, to advocate for dentistry within national action plans on antimicrobial resistance (AMR), and to support members of the profession to use antibiotics responsibly. To support delivery of this goal, FDI produced a pledge for them to tackle antibiotic resistance by implementing local activities, such as raising awareness, preventing dental infections and optimising antibiotic prescribing: www.fdiworlddental.org/antibiotic-resistance-needs-tackling-immediately-across-dentistry. Launched during WAAW 2021, >60 NDAs and 50 other dental organisations/individuals have signed so far.

3. Capacity of researchers
Launched at International Association for Dental Research (IADR) 2021 to build capacity for research about dental antimicrobial prescribing resistance and stewardship, FDI’s Global Antimicrobial Research in Dentistry early career researcher network already has ~100 members from around the world. Details of its monthly online journal club are advertised via its LinkedIn forum. At these lively Zoom events, volunteers present their recent research (14 presentations so far) and ideas for future collaborations are generated. The results of one such study reviewing guidelines in Latin America were presented at IADR 2022. Another study involved co-developing international consensus on a core outcome set for dental antibiotic stewardship with patients, clinicians and academics participating in the study (https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-022-06038-w).

Future Development

1. Engaging the public
Responding to feedback from the online course, a set of resources highlighting the benefits of managing dental pain and infection without antibiotics will aim to reduce professional intention to prescribe and public desire for antibiotics by tackling the erroneous yet widespread perception that antibiotics are necessary and appropriate for treating acute dental problems (https://academic.oup.com/ijpp/article/29/3/210/6227947). FDI intends to produce awareness raising poster, leaflets and videos which can be used globally. Template resources for member National Dental Associations and other partners will also be provided which can be adapted to address local problems, such as over-the-counter access to antibiotics.

2. National and international action
FDI will continue to use its influence to encourage the inclusion of dentistry within national action plans on AMR and vice versa (AMR within oral health plans). FDI is particularly pleased that WHO recently incorporated AMR into its global oral health action plan.

World Dental Congress Sydney 2023 will be the first in-person event since the white paper’s publication. A celebratory event for signatories of FDI’s pledge is planned, to publicly share their successes and encourage a wider range of signatories, including from South America, Africa, businesses and charities involved with dentistry.

3. Collaborative research and mentoring
International collaborative research through the Global Antimicrobial Research in Dentistry network will be our future focus for active engagement with academic stakeholders. Network members will be involved with disseminating the results of our studies, including the review of Latin American guidelines and the international consensus on a core outcome set for dental antibiotic stewardship once they are published.

Collaboration is just starting on an international survey to identify patterns of practice and attitudes towards antibiotic prophylaxis for surgical site infections following dental procedures. This will be the first project to benefit from the network’s mentoring programme.