Knowledge, attitudes and influencers of pet-owners surrounding antimicrobials and antimicrobial stewardship in North America

The primary aim of this research project was to establish the current knowledge, attitudes and influencers (KAI) of North American pet-owners with respect to antimicrobial stewardship (AMS) and resistance (AMR). A secondary aim was to utilise a novel survey technique to identify what aspects of antimicrobial drug prescriptions petowners view as important for their animal. The project was divided into two parts, which are described in the two chapters below. Chapter 2 explores the KAIs of North American dog-owners. Three populations were surveyed via an online questionnaire: dog-owners in the United States, dog-owners in Canada, and dog-owners recruited via educational social media (ESM). A novel study methodology (conjoint analysis) determined to what extent specific features (cost, method of administration, and importance in human medicine) influenced dog-owner decision-making when selecting between two antimicrobials. We determined that cost had the largest influence on a dog-owner’s choice between two (otherwise similar) antimicrobials, accounting for 47% of the decision-making preference. Method of administration accounted for 31%, and drug importance in human medicine had the smallest influence (22%). All groups preferred low-cost medications that were administered once by injection. Canadian and US participants were more likely to prefer drugs that were “very important” in human medicine whereas ESM participants preferred drugs that were “not important.” In the descriptive (KAI) analyses, dog-owners were asked a series of closed-ended Likert questions. The majority (86%) of participants considered AMR to be important. In contrast, only 29% of dog-owners reported that antimicrobial use (AMU) in pets posed a risk to humans. This study determined that the dog-owners surveyed prioritise cost over all other features when their pets are prescribed an antimicrobial, despite considering AMR important. Chapter 3 describes cat-owner understanding and priorities when their pet is prescribed an antimicrobial drug. Cat-owners were recruited and surveyed in the same manner as dog owners in chapter 2. Conjoint analysis was used to calculate what proportion each of the three features (cost, dosing frequency, and importance in human medicine) of a prescription influenced cat-owner preferences when choosing between antimicrobials for their cat. Method of administration (38%) and cost (37%) had a similar weight in owner decision-making. Drug importance in human medicine had the smallest impact on the decision-making process (25%). The most desirable drugs were low-cost, single injection medications that were “very important” in human medicine for the US and Canadian groups. Conjoint analysis for the ESM group was not available. Analysis of cat-owners’ KAIs revealed that 86% reported AMR to be important in human medicine. However, only 28% stated that AMU in pets may be a risk to humans. This study demonstrates that North American cat-owners are equally concerned by cost and ease of drug administration. Cat-owners appear to have low levels of understanding of AMR in pets and view it as lower priority when their animal is prescribed an antimicrobial medication. Our work indicates knowledge of AMR in human and veterinary medicine is limited. Education and inclusion of pet-owners is likely to be an important component of future AMS efforts