Barriers to Judicious Use of Cefovecin in Cats

In the Literature

Cazer CL, Lawless JW, Frye A, Gonzalez L, Safi AG. Divergent veterinarian and cat owner perspectives are barriers to reducing the use of cefovecin in cats. J Am Vet Med Assoc. 2023;261(12):1810-1819. doi:10.2460/javma.23.08.0487

The Research …

Cefovecin is a third-generation cephalosporin available as a long-acting injection for dogs and cats. Third-generation cephalosporins are listed as Critically Important, Highest Priority antimicrobials for human medicine by the World Health Organization and are thus discouraged as first-line treatment in veterinary patients; however, cefovecin historically accounts for approximately one-third of all antimicrobial use in cats.^1-5

Authors of this study sought to identify why clinicians prescribe cefovecin to cats, particularly when a clear indication is lacking, and understand pet owner and clinician motivators and barriers to oral antimicrobial use. An online survey completed by 600 cat owners in the United States collected information on experiences and attitudes toward administering oral medication, as well as awareness of antimicrobial resistance. In addition, 21 small animal clinicians in the United States were interviewed regarding decision-making when selecting antimicrobials for cats (both in general and for cefovecin specifically). Owner data were analyzed statistically, and clinician data were analyzed via qualitative methods.

When prescribing antimicrobials to cats, clinicians reported considering clinical need, patient age and comorbidities, diagnostic confidence (eg, just-in-case prescribing when the need for antimicrobials is unclear), and perceived pressure from pet owners or colleagues. Many clinicians stated they choose cefovecin because of its injectable formulation, particularly in fractious cats or cats with oral pain. Some clinicians assumed older, disabled, busy, or single owners might struggle to administer oral antibiotics. Clinicians estimated 60% of cat owners have difficulty administering oral medications to their cat and 20% are unable to do so; however, only 31% of owners reported difficulty administering oral tablets to their cat, and only 9% reported inability to do so, with a lower percentage expressing concern about administering oral liquids. Less than half of owners (46%) recalled being shown how to administer oral medications by veterinary staff.

… The Takeaways

Key pearls to put into practice:

• Although cefovecin can be useful in cases with clear administration barriers, third-generation cephalosporins are Critically Important, Highest Priority antimicrobials in humans; prescribing for convenience or due to low diagnostic confidence is therefore not warranted.⁴ Aminopenicillins and first-generation cephalosporins may be good alternatives to reduce risk for antimicrobial resistance.^6,7 Use of antibiotics should be guided by culture and susceptibility testing or Gram-stained cytology results.

• Shorter courses of antimicrobials may be as effective as longer courses.⁸ Updated consensus guidelines should be consulted for recommended treatment lengths.

• Cat owners should not be assumed to be unable or unwilling to learn how to administer oral medications. Veterinary staff should help improve owner confidence in administering oral antimicrobials. Structural interventions include allocating more time for owner education and providing administration tools (eg, pill poppers). Video demonstrations can also be provided.⁹ In this study, owners reported mixing oral medications in food was the most successful administration method.

• Communicating with owners when antimicrobials are not needed is also important. Pressure to prescribe antimicrobials may be reduced if owners understand why they are not warranted. Information about antibiotic use can be included in newsletters, on waiting room walls, and on social media and should be reiterated during consultations. Owners are likely to be receptive to clinical advice on optimal care for their cats.