Antimicrobial use and antimicrobial resistance: standpoint and prescribing behaviour of Italian cattle and pig veterinarians

Figures & data

Table 1. Socio-demographic characteristics of the two target groups (n_{cattle vets} = 422, n_{pig vets} = 96).

Characteristics	Cattle veterinarians	Pig veterinarians
	(%)	(%)
Gender
Male	85.8	79.2
Female	14.2	20.8
Age
< 45	36.3	34.4
45–60	52.1	46.9
> 60	11.6	18.7
You deal with …
Livestock animals	64.2	79.2
Both pets and livestock animals	35.8	20.8
How long have you been working as veterinarian?
< 10 years	23.7	16.7
10–20 years	20.1	29.2
> 20 years	56.2	54.1
Position
Private veterinarian	68.5	72.9
Public veterinarian	31.5	27.1

Table 2. Opinions on AMU and antimicrobial prescribing habits of survey respondents (n_{cattle vets} = 422, n_{pig vets} = 96).

Statements	Cattle veterinarians	Pig veterinarians	Chi-square	p-value
	(%)	(%)
Do you think that AMU in the rearing farms in which you work is …
Adequate, in line with the National and European guide lines	40.3	46.9	1.752	.416
Not always in line with the National and European guide lines	53.3	48.9
I don’t know	6.4	4.2
(For those who stated that they prescribe antibiotics) How frequently do you prescribe antibiotics for prophylactic purposes?^a
Often (every day)	6.9	10.3	3.989	.263
Sometimes (1–2 times a week)	24.7	33.8
Rarely (2–3 times a month)	45.4	38.2
Never	23.0	17.7
(For those who stated that they prescribe antibiotics) How frequently do you prescribe antibiotics for therapeutic purposes?^a
Often (every day)	37.2	30.9	3.514	.319
Sometimes (1–2 times a week)	43.1	54.4
Rarely (2–3 times a month)	18.4	14.7
Never	1.3	0.0
(For those who stated that they prescribe antibiotics) Do you suggest or prescribe alternative strategies/ therapies to antimicrobials^a
Yes, often	8.5	13.2	3.647	.302
Yes, sometimes	31.3	38.2
Yes, rarely	24.7	17.7
No, never	35.5	30.9

^an_{cattle vets} = 304, n_{pig vets} = 68.

AMU: Antimicrobial usage.

Table 3. Respondents’ agreement with some statements on AMU and AMR (n_{cattle vets} = 422, n_{pig vets} = 96).

Statements	Cattle veterinarians	Pig veterinarians	Chi-square	p-value
	(%)	(%)
Inadequate AMU in animals is dangerous for their health
Not at all or slightly agree	14.0	16.7	0.456	.500
Somewhat or strongly agree	86.0	83.3
Inadequate AMU in animals is dangerous for human health
Not at all or slightly agree	13.3	19.8	2.686	.101
Somewhat or strongly agree	86.7	80.2
Antimicrobials are over-used in Italian rearing farms
Not at all or slightly agree	23.5	25.0	0.102	.749
Somewhat or strongly agree	76.5	75.0
AMR is a relevant problem in Italy
Not at all or slightly agree	23.2	28.1	1.027	.311
Somewhat or strongly agree	76.8	71.9
Prescribing broad-spectrum antibiotics in rearing farms increases the antimicrobial resistance
Not at all or slightly agree	30.6	40.6	3.609	.050
Somewhat or strongly agree	69.4	59.4
The preventive use of antibiotics fosters the development of AMR
Not at all or slightly agree	14.2	30.2	14.05	.000
Somewhat or strongly agree	85.8	69.8
Alternative methods currently available (homeopathy, phytotherapy, etc.) could be an efficient alternative to antimicrobial treatment
Not at all or slightly agree	83.9	74.0	5.233	.022
Somewhat or strongly agree	16.1	26.0

AMU: antimicrobial usage; AMR: antimicrobial resistance.

Table 4. Factors influencing the choice of antibiotics to be prescribed. Median values (Likert scale from 1 minimum to 10 maximum, n_{total sample} = 372, n_{cattle vets} = 304, n_{pig vets} = 68).

Factors	Total sample	Cattle veterinarians	Pig veterinarians	Standardized test	p-value
Efficacy	10	9^a	10^a	2.964	.003
Field experience	9	9	9	1.687	.092
Training/scientific knowledge	9	8	9	0.754	.451
Current legislation	8	8^b	9^b	2.723	.006
Duration of the withdrawal period	9	9	8	–1.264	.206
AMR risk	8	8	8	–0.871	.384
Laboratory diagnosis including drug susceptibility testing	8	8	8	1.600	.110
Ease of administration	8	8	7.5	0.457	.647
Guidelines or national/international protocols on the rational use of drugs	7	7	7	0.394	.693
Price	7	7^c	6^c	–2.894	.004
Avoiding CIAs (critically important antimicrobials)	6	6	5	–0.967	.333
Easy access in the market	6	6	6	–1.092	.275
Opinion of a colleague	6	6	6	1.341	.180
Habit	5	6^d	4^d	–3.550	.000
Fear of penalties	5	5	6	0.702	.482
Opinion of the farmer	3	3	3	1.006	.314
Pharmaceutical representatives	3	3	3	–1.692	.091
Advertisement	2	2	2	–1.608	.108
Opinion of the pharmacist	1	1	1	–0.253	.801

^aCattle: (first quartile; third quartile) = (9; 10) | Pig: (first quartile; third quartile) = (9; 10).

^bCattle: (first quartile; third quartile) = (6; 10) | Pig: (first quartile; third quartile) = (7; 10).

^cCattle: (first quartile; third quartile) = (5; 8) | Pig: (first quartile; third quartile) = (3.25; 7.75).

^dCattle: (first quartile; third quartile) = (3; 7) | Pig: (first quartile; third quartile) = (2; 6).

Table 5. Main alternative strategies suggested by the cattle veterinarians and the pig veterinarians (total occurrences and percentages, n_{cattle vets} = 196, n_{pig vets} = 47).

	Cattle veterinarians			Pig veterinarians
Main alternative strategies to antimicrobials	Occurrences	%	Rank	Occurrences	%	Rank
Hygiene/Biosecurity/Management	48	15.7	1	11	13.1	3
Phytotherapy	46	15.1	2	9	10.7	4
Homeopathy/Homotoxicology	42	13.8	3	1	1.2	8
Anti-inflammatory	41	13.4	4	5	5.9	6
Vaccines	34	11.1	5	7	8.3	5
Nutritive principles	23	7.5	6	14	16.7	1
Immunostimulants	16	5.3	7	3	3.6	7
Pre-/Probiotics	10	3.3	8	12	14.3	2
Disinfectants/Antiseptics	8	2.6	9	1	1.2	8
Essential oil	3	1.0	10	5	5.9	6
Acidifying substances	1	0.3	11	9	10.7	4
Other	33	10.8	–	7	8.3	–

Figure 1. Word cloud of the strategies proposed by the cattle veterinarians. ^aWords with a greater number of occurrences included ‘Rearing farm’, ‘Animal’, ‘Farmer’, ‘Biosecurity’, ‘Veterinarian’, ‘Antibiotic’, ‘Animal welfare’, and ‘Welfare’.

Figure 2. Word cloud of the strategies proposed by the pig veterinarians. ^aWords with a greater number of occurrences included ‘Biosecurity’, ‘Rearing farm’, ‘Vaccinate’, and ‘Improve’.