What is the Antibiotic Amnesty?

Pam Mosedale BVetMed MRCVS, QI Clinical Lead
Fergus Allerton BSc BVSc CertSAM DipECVIM-CA MRCVS

RCVS Knowledge
Welcome to this VetTeamAMR podcast from RCVS Knowledge. Leading responsible antimicrobial use in farm, companion and equine teams.

Pam Mosedale:
Hi everyone. Today I’m going to talk to Fergus Allerton. Fergus is the chairman of SAMSoc. That’s the Small Animal Medicine Society. He is the AMR lead at Linnaeus. And I’m going to talk to Fergus about
the antibiotic amnesty. Hi Fergus.

Fergus Allerton:
Hi. Thanks for the introduction.

Pam Mosedale:
No problem. What is this antibiotic amnesty thing then?

Fergus Allerton:
This is an idea that’s come across from NHS Midlands. They ran an antibiotic amnesty last November and they encouraged people to return their unused antibiotics back to the pharmacy. And the idea is
to try and ensure their safe correct disposal. We want to avoid them going into the environment causing environmental pollution or being used for the wrong reason inappropriately. Something that well, even our health secretary recently advocated.

Pam Mosedale:
Yes. And certainly when I was in practice, I’ve got plenty of experience of clients coming in, having used the antibiotics they got for their dog about two years ago just to first before they bother coming to the surgery. So it’s definitely an issue, isn’t it?

Fergus Allerton:
And it’s one that could cause problems. If you use antibiotics when they’re not the right thing you could delay diagnosis, you could cause side effects. And we want to try and make sure that antibiotics are only prescribed by vets and doctors and are used when appropriately, not when owners think that they might be helpful.

Pam Mosedale:
That right. So how can practices get involved in this amnesty?

Fergus Allerton:
Well, we recognize that practices are incredibly busy at the moment so we’ve tried to make this as easy as possible to get involved with. The RCVS Knowledge and the RUMA Companion Animal and Equine websites have a host of resources available. These are easily downloadable. They include posters that you can put up in the practice to highlight the amnesty. We would ask that practices
have a dedicated pharmaceutical collection bin at reception and they encourage their pet owners to return any unused out of date antibiotics during the month of November. And we would like to
record how much we can get back. I’ll mention that again in a moment.

But BSAVA and some of our other supporters have offered a
range of prizes to practices that engage in the amnesty. So there’s a really good carrot as well. We would love to know how much we get back to evaluate the impact of this amnesty. But for me, the
biggest win is going to be the raised awareness. The more we talk about antimicrobial resistance and the correct proper use and proper disposal of antibiotics, the better. The more people that know about it, the greater the chance that we have of tackling this potentially apocalyptic problem to society.

Pam Mosedale:
That’s great that you’re going to make it easy for practices because as you say, a lot of practices are really inundated I would say at the moment, aren’t they? So that’s good. And is there going be any
publicity actually to the owners as well?

Fergus Allerton:
We’re going to try and get the word out by any channels that we can. And we have created some multimedia social media resources, including a short animation film. We’ve got some tweets and
things like that that we encourage practices to share via their Facebook pages, their Twitter pages and other resources to try and make this conversation happen as often as it can be. So if vets can
mention it during consults, that would be brilliant. If reception staff can highlight and point owners towards the posters, we would really like people to find out and get involved in it.

And the reason it’s running in November is to coincide with World Antibiotic Awareness Week. So you’ll see lots of things happening towards the end of November – 18th till the 24th. We might even
see Blackpool Tower going blue to highlight antibiotic awareness. And there’s lots and lots of little initiatives that will coincide with this. And the amnesty is just one angle that we’re trying to take to raise awareness about this issue.

Pam Mosedale:
Brilliant. And the week is 18th to 24th November, but the amnesty is the whole month, is it?

Fergus Allerton:
That’s exactly correct, yes. So we want to maximise the opportunity, start these conversations happening from next Tuesday and try and recover some of the unused antibiotics out of people’s bathroom cabinets, et cetera.

Pam Mosedale:
That’s great that you’ve got ready made social media resources because that’s so much easier for practices to just retweet all the things that you do on social media, use the Facebook posts and get
to their clients that way. So I think that that’s a great idea. But being an ex-practice owner myself, I have to ask you this, will there be any costs for practices?

Fergus Allerton:
Yes. Unfortunately there is a small cost associated with correct pharmaceutical disposal. Can’t deny that, but this is so much better than the alternative. Studies in people have shown that one third of
people throw their antibiotics either down the toilet or into household waste and all that’s going to do is contaminate our environment. We’ve seen this year what happens to our sewage. It goes direct into the sea and into our rivers, and it’s going to aggravate the problem of antimicrobial resistance.

We are the custodians of the antibiotics that we have sold to people to try and make their pets better. If for whatever reason those antibiotics haven’t ended up in their pet, we want to now make sure that they are properly disposed of. And so we are asking them to be returned to our vet practices and we accept unfortunately, that they will be a small cost to the appropriate pharmaceutical disposal. But that is a very small cost and one that I think we need to bear. As part of practice standard scheme from June next year, it will be compulsory to advertise the correct return and to advocate that.

Already, if they give them back, we have to dispose of them by these routes, so we have to do it properly. If they do it from next June, we’ll have to advertise and promote the correct return. So let’s just get ahead of the game and start doing it the right way from next week.

Pam Mosedale:
Absolutely. I couldn’t agree more. Being an ex-lead assessor of practice standards, I’m very keen that people dispose of all their waste correctly and all their medicines correctly. Not just the antibiotics I
mean, controlled drugs, everything, it’s just socially responsible to take all those medicines, but not to leave them out in society, as you say. But particularly in this case for the antibiotics. So it sounds
like it’s quite easy for practices to join in then?

Fergus Allerton:
It really should be. And we provided these resources. Do look at these websites and we’ll provide the links alongside this podcast. But do access the resources, use what you think is helpful for your practice. If it’s useful to put the animation video on a waiting room TV screen, do that. If you want to share these things on your social media pages, please do. Put the posters up. The posters contain a little QR code, and that links to a survey. And we’re really keen to hear from clients, hear from pet owners.

What do they think of the antibiotic amnesty? Why have they ended up with antibiotics anyway? Were the courses prescribed too long? Did the animal get better sooner? Were the antibiotics not tolerated? Did they cause adverse effects? Did the client get bitten five times and give up trying? We want to understand what are the reasons for leftover antibiotics, and we also want to get a better picture of owner awareness of the correct roots of disposal.

Did they know the damage that could be caused from throwing them down the toilet or into the household waste? Or from using them on another pet or themselves? Heaven forbid. So we want to
make sure that we learn from this experience. This is the first and largest veterinary antibiotic amnesty ever to have taken place. And we want it to be a success, but we want it to be a learning experience as well so that we can in future, improve the way that we use antibiotics and make sure that we help educate owners as to safe disposal.

Pam Mosedale:
And I think you’re right, lack of compliance can be a major, major factor, especially with cats. Is this just for a small animal antibiotics or is it covering equine and farm as well?

Fergus Allerton:
It covers equine as well, and we would love horse owners to be involved in this. It’s a bit more complicated in the farm situation. So we recognize that RUMA have done a phenomenal amount of
great work already, and farmers are very aware of the importance of appropriate antibiotic use, but they’re less commonly seeing individual cows having their own bottle of antibiotics. So they may be
using it on other animals under the direction of vets in an appropriate way. So they have appropriate roots of disposal already available to them, and we want to encourage them to continue using those
channels.

Pam Mosedale:
But you’d be keen if the horse owners had antibiotics to bring back too. So for mixed practices, it’s good to raise awareness anyway, isn’t it, with mixed practices?

Fergus Allerton:
Absolutely. Mixed practices, cats, dogs, horses, small animals.

Pam Mosedale:
Exotics.

Fergus Allerton:
Exotics, absolutely. Anything, we just don’t want them going into the bin.

Pam Mosedale:
Brilliant. Well, it’s obvious that you’re so enthusiastic about this, Fergus, and I think it’s such a majorly important thing for all of us, for all our futures, isn’t it?

Fergus Allerton:
Absolutely. And I should stress, it’s very much not a single person amnesty. We have been delighted by the engagement across the veterinary profession. So we have the VMD, we have BSAVA, BEVA,
we have RCVS, RCVS Knowledge, and I’m going to miss too many people to name them all, but lots of the veterinary corporates are really behind this and supporting this 100%. We’ve got practices,
independent practices that are really engaged with it. And it is an opportunity for all practices to engage in this important one health task. This affects animal owners and ourselves as well.

If you happen to live in the Midlands, take your own antibiotics back to your local pharmacy. They’re involved as well, and they want to be part of it. And because it’s a knock on effect, it will help everyone if we dispose of antibiotics appropriately.

Pam Mosedale:
Brilliant. So get involved.

Fergus Allerton:
Absolutely. And hopefully this is a low input, shouldn’t take much work, I promise, high output, increased awareness, safe disposal of antibiotics initiative. So please do get involved. It really does help.

Pam Mosedale:
Brilliant. Thank you, Fergus. And I hope everyone’s taking that on board, and it’ll be interesting to see how many antibiotics we get handed in.

Fergus Allerton:
Absolutely. I mentioned the prizes at the beginning, butPam

Pam Mosedale:
Oh yes.

Fergus Allerton:
… do look at those. They’re well advertised on both our sites. But you’ll see that there is access to BSAVA Congress, access to Beaver Congress. There’s RCVS Knowledge access. There’s Webinar Vets have offered access for a year. There’s NOAH compendiums and BSAVA manuals also available.

These are great prizes and all you need to do is report your feedback to BSAVA. There’ll be links on the websites. Report that at the end of the amnesty come December, and you could find yourself hearing more about this at BSAVA Congress next year.

Pam Mosedale:
Brilliant. And the real prize is reducing antimicrobial resistance, isn’t it?

Fergus Allerton:
That’s it. You’re 100% right, yes. That’s all working together we can really help reduce this problem.

Because if we don’t, the deaths already reported in the Lancet article just last year, 3 million people per year across the globe dying from multi-drug resistant infections. We’ve got to do something. We’ve got to stop this otherwise it could affect us all.

Pam Mosedale:
Well, with that fact, we will finish. But thank you very much, Fergus.

Fergus Allerton:
Thank you very much indeed.

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