Antimicrobials for bovine respiratory disease (Proceedings)
Aug 01, 2010
CVC IN KANSAS CITY PROCEEDINGS
Drugs can be selected by using the principles of evidence-based veterinary medicine:1. Based on a need for information (a single animal or herd outbreak of respiratory disease), ask a clinically relevant question, including Patient, Intervention, Comparison, and Outcome (PICO).
• The purpose of the clinical question is to focus your information search and to identify what you are really interested in answering. A vague clinical question will not result in good clinical decision-making.
• Some examples of relevant clinical questions associated with the therapy of respiratory disease include: In high risk recently weaned calves that have just arrived at a feedlot, which drug product has been shown to decrease mortality? In pre-conditioned, recently-weaned calves headed for backgrounding, has metaphylaxis been shown to reduce costs of disease, including morbidity, mortality, and cost of gain? In dairy cows with signs of respiratory disease, has a particular drug product been show to be more effective at return to production?
• Clinical questions can be asked about a current problem, or they can be anticipated: a plan to wean calves in the fall suggests a need for information on treating respiratory disease in these calves prior to the fall season.
2. Using the clinical question, search for all the available published evidence to answer the question.
• Typically, this step is searching in the published biomedical and animal science literature. While this may be a prolific source of data, in some cases, evidence may be lacking in the published literature and must be found elsewhere. Technical reports from animal health companies on the subject of bovine respiratory disease therapy abound. In addition, well-designed animal record systems with good acquisition of high quality data may also be a source of evidence, although the emphasis needs to be on "high quality data". Bad data is usually worse than no data at all. The use of anecdotal data or clinical impression is always fraught with opportunities for misinterpretation and should generally be avoided. Our minds are not designed to retain the best evidence but rather to retain the interesting, unusual, and exciting evidence. This is not to argue that we do not recognize patterns – that is the basis of many clinical diagnoses. However, patient outcomes are best analyzed via written record rather than recollection of clinical cases.