兽研引言
过去十年间，人们对使用抗寄生虫药对更广泛环境影响的担忧日益增加。1,2 近期一项研究发现，氟虫腈和吡虫啉在英国淡水中持续存在，浓度对水生生物有害3,4，持续时间长达60天。5 了解处方行为对于制定有针对性的干预措施以维持抗寄生虫治疗疗效至关重要。6 实施管理计划对于确保负责任的处方实践至关重要，正如抗菌药物所显示的那样。7,8 此外，兽医对抗寄生虫药使用更广泛后果的认知在很大程度上仍未得到探索。
抗寄生虫药影响“同一健康”三元组的所有方面，包括环境污染、兽医患者的耐药性以及向人类的人兽共患传播。7,9 加之药物开发不足，10 这些因素使得审慎的处方实践成为必要。采用跨学科方法进行抗寄生虫处方对于实现这一目标至关重要，它提供更广泛的知识基础，考虑动物、人类和环境，并支持通用卫生控制政策。7 这种方法可以增强对人兽共患疾病在动物与人类之间传播的理解，并强化主动干预的必要性。7 负责任的兽医处方是减轻这些风险的关键策略。然而，需要行业层面的变革才能产生显著效益。11
尽管越来越多的证据表明抗寄生虫药物造成环境污染并对昆虫种群产生负面影响，但兽医药品管理局目前不要求对小型动物抗寄生虫药进行环境安全检测。12,13 研究表明，吡虫啉的使用导致蜜蜂健康所必需的69%生物元素出现缺乏。14
抗寄生虫药耐药性构成重大的公共卫生威胁，且动物预防性使用的药物往往与人类医学所用药物重叠。7 COVID-19提高了公众对综合卫生政策重要性的认识，使观念转向“同一健康”原则。7 有效的抗寄生虫控制需要关注环境卫生、个体化风险评估和适当的饲养管理实践。就这些因素与客户沟通和教育是抗寄生虫管理不可或缺的组成部分，可显著提高依从性。15,16 全球超过50%的人口拥有宠物，将客户视角纳入决策代表着一个机会，可就人兽共患风险16以及环境影响对宠物主人提供指导和教育，这是抗寄生虫管理的重要组成部分。
抗生素管理计划已被证明能有效减少抗菌药物的过度使用和不适当处方，8 提示类似的抗寄生虫举措可能有益。通过分析兽医处方模式，这些计划为旨在促进行为改变的干预措施提供了基础，17 特别是在减少广泛的预防性抗寄生虫使用方面。12 负责任处方对于维持长期疗效、减轻耐药风险和环境污至关重要，抗寄生虫药占兽药产品的39%。18
大多数研究集中于抗寄生虫药在牲畜中的使用，而对其在伴侣动物中的使用了解较少。在此背景下，本研究专门探讨其在猫中的使用。据作者所知，本研究首次定性调查英国猫抗寄生虫处方的行为驱动因素。创建了一项调查，由16名英国兽医作答。受访者被要求指出他们在为猫开具抗寄生虫药时考虑不同因素的程度，包括环境污染、局部寄生虫分布、动物年龄、给药便利性、动物生活方式、购买偏好实践、客户偏好和寄生虫耐药风险。
方法
参与者于2024年2月22日至2024年3月6日期间通过萨里大学兽医学院合作实践网络以非概率便利抽样方式招募。通过一封介绍性电子邮件邀请皇家兽医学院注册兽医，邮件包含研究目标详情和调查链接。纳入标准为参与者在研究前4个月内开具过抗寄生虫药处方，且目前在小动物诊所工作。提供抽奖作为参与激励。调查数据安全存储于在线调查平台（JISC v3）内。
在线调查使用JISC设计，结构旨在调查影响兽医抗寄生虫处方行为的因素。调查包含29个问题，以人口统计学信息开始，包括年龄、性别、执业县、资格获得地点和执业地点，以及是否在过去4个月内开具过抗寄生虫药处方。后续部分使用五点、七点和八点李克特量表以及开放式自由文本字段的组合来探索处方行为，以获取定性见解。
本研究开展了一项涉及四名兽医的试点研究，以评估调查条目的清晰度和相关性；他们的回答被排除在最终数据集之外。尽管调查包含了与犬和猫患者抗寄生虫处方相关的问题，但数据收集和分析由两名独立研究人员分别对每个物种进行。由于猫科动物与犬科动物在生活方式上存在显著差异，本研究仅关注猫患者的处方实践。它们的自由 roaming 天性意味着捕食是寄生虫传播的关键途径，并显著增加了暴露风险。18, 19
调查回答从 JISC 导出至 Microsoft Excel（版本 16.81）以便熟悉和存储数据。应用描述性统计分析数据，包括 Likert 量表问题的百分比。数据集包含名义变量，包括性别和执业年限，以及有序变量（常规预防中抗寄生虫处方的频率、制定个体化寄生虫控制计划的频率（纳入基于风险的寄生虫控制）、寄生虫诊断检测的频率，以及对定期诊断检测的重视程度），还有人口统计学信息。调查问卷包含在支持信息中，开放式问题的回答在“结果”部分提及。
结果
共收到 16 份回答。所有参与者均为符合纳入标准的注册小动物执业兽医。其中，11 人自我认同为女性，4 人为男性，1 人不愿透露性别。给药便利性、动物生活方式和诊所采购偏好决定了兽医的抗寄生虫药处方。高比例的处方兽医在决策过程中未考虑环境污染和寄生虫耐药性的风险（图 1）。
[图：兽医对影响其在临床实践中为猫开具抗寄生虫药物处方的因素的认知]
共 63% 的参与者认为预防性给予抗寄生虫药是猫患者最合适的处方策略。25% 的受访者总是开具抗寄生虫药物，69% 的受访者经常开具。两名参与者报告“跳蚤感染风险高”，且感染可能对动物福利产生重大影响。
尽管 32% 的参与者认为定期寄生虫诊断检测中等或非常重要，但仅 6% 报告常规进行治前诊断检测。个体化寄生虫控制计划的频率各不相同；13% 的受访者总是实施此类计划，而大多数有时实施（38%）或很少实施（25%）。
63% 的参与者有时阅读关于抗寄生虫药潜在风险的文献，尤其是在“同一健康”框架内的文献，25% 的参与者很少阅读。此外，50% 的受访者不同意以下陈述：“关于伴侣动物寄生虫感染的预防和控制，有足够的知识和理解”。
在报告的驱虫产品中，Advocate（吡虫啉和莫昔克丁）和 Droncit（吡喹酮）是最常开具处方的药物，分别被 88% 和 81% 的受访者提及，而 Milpro 未被任何参与者开具处方（表 1）。
TABLE 1. Most commonly prescribed antiparasitic medications to cats by small animal veterinarians practicing in the UK ( n = 16).
| Brand name (active ingredient) | Percentage of respondents (%) |
|---|---|
| Milpro (praziquantel and milbemycin oxime) | 0 |
| Other | 6 |
| Stronghold (selamectin and sarolaner) | 6 |
| Broadline (eprinomectin and fipronil) | 6 |
| Nexguard Combo (praziquantel) | 13 |
| Panacur (fenbendazole) | 38 |
| Credilo (lotilaner) | 63 |
| Droncit (praziquantel) | 81 |
| Advocate (imidacloprid and moxidectin) | 88 |
讨论
本研究旨在探索小动物执业兽医的抗寄生虫药处方行为，并确定影响处方决策的关键决定因素。迄今为止，尽管猫暴露于寄生虫的风险很高，但专门针对猫寄生虫预防的研究有限。19 有效行为干预措施的制定依赖于对处方行为的清晰理解。6 鉴于对含吡虫啉、12 氟虫腈 20 和氟雷拉纳（后者通过粪便排泄持续数周）21 产品造成环境污染的认识日益增加，这一问题尤为相关。虽然现有研究大多集中在抗生素处方上，但行为干预的基本原则可转移至寄生虫学领域。在发达国家，50% 的人与伴侣动物共同生活，22 这凸显了兽医在寄生虫控制中以保障人类健康（尤其是那些可能面临更高疾病风险的人群）和动物福利方面的重要作用。
宠物主人、执业偏好和给药便利性被确定为影响猫用抗寄生虫药处方的重要因素。共有95%的参与者报告定期开具局部用抗寄生虫药物。给药便利性在猫科医学中起着关键作用：项圈、跳蚤滴剂和寝具等局部用产品已被确定为污染来源。12，13 需要进一步研究替代性防控方法在预防性抗寄生虫药给药方面的有效性。
客户偏好也影响了兽医的产品选择。虽然顺应主人偏好可能提高依从性，但兽医应考虑耐药性发展和环境污染的风险。该领域的大部分研究是在农场动物和马医学中进行的，限制了对猫用抗寄生虫药环境影响得出结论的能力。23，24 由于目前证据不足，抗寄生虫治疗带来的环境风险了解甚少，需要进一步研究以量化环境暴露水平、描述环境暴露途径的特征，并识别由此产生的任何环境危害。18
在不了解耐药性模式的情况下，实施适当的缓解策略具有挑战性。22 在本研究中，69%的受访者表示当地寄生虫分布影响了他们的处方选择，兽医们表达了在抗菌药物管理项目中接受进一步培训和教育的意愿。欧洲伴侣动物寄生虫科学委员会制定的指南可用于辅助基于个体风险的处方，并减少这些产品的“不加区分的预防性使用”。12 然而，参与者中并未广泛阅读关于抗寄生虫指南和“同一健康”原则的现有文献。这种参与度的缺乏令人担忧，因为它可能反映了专业人员对这些问题的认识存在更广泛的差距。
本研究受限于参与兽医样本量较小。由于各合作诊所的兽医人数未知，无法计算应答率。参与者的临床经验水平各不相同，其对该研究中耐药性、环境污染或该主题在“同一健康”框架内重要性的认知影响程度仍不清楚。此外，16名受访者中有11人在肯特郡执业；因此，研究结果可能不能代表更广泛的英国兽医行业。鉴于临床实践中决策的复杂性，在推断这些结果时应谨慎。鉴于该主题的重要性，迫切需要开展涉及英国以外更广泛受访者的进一步研究，以加强“同一健康”管理。
结论
本研究表明，尽管环境污染和抗寄生虫耐药性持续成为关键问题，但在兽医实践中，优先考虑便利性和客户满意度仍是普遍现象。为有效应对这些挑战，抗寄生虫管理策略不仅必须纳入循证指南，还必须纳入针对处方兽医的行为干预措施。兽医教育可能有助于未来的战略性寄生虫控制工作。建议开展包括更大规模和国际受访者群体的进一步研究，以增强科学贡献。制定全行业管理项目以指导兽医决策，可能在保护人类和动物健康以及限制环境影响方面带来益处。
作者贡献
Rosie Elizabeth Hobbs进行了文献检索、数据收集和论文的初步撰写。Aneta Duszak‐Kowal在论文编辑方面做出了重要贡献，并提供了该主题领域的专业知识。两位作者均同意提交给出版商的最终稿件版本。
利益冲突
作者声明他们无利益冲突。
伦理声明
本研究获得了萨里大学兽医学院的伦理批准。未收集任何个人或可识别数据，确保受访者保密。在参与调查前获得了知情同意。为激励完成调查，设置了抽奖活动（SageHDR：1046015‐1045997‐116939968）。
知情同意
在参与调查之前，已从所有参与者处获得知情同意。
支持信息
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INTRODUCTION
Concerns about the effect of the use of parasiticides on the wider environment has increased over the decade. 1 , 2 A recent study found that fipronil and imidacloprid persist in UK freshwaters at concentrations harmful to aquatic organisms 3 , 4 for up to 60 days. 5 Understanding prescribing behaviour is essential for developing targeted interventions that maintain antiparasitic treatment efficacy. 6 The implementation of stewardship programmes is crucial for ensuring responsible prescribing practices as has been shown with antimicrobials. 7 , 8 Furthermore, veterinarians' awareness of the broader consequences of antiparasitic use remains largely unexplored.
Antiparasiticides impact all aspects of the One Health triad, including environmental contamination, drug resistance in veterinary patients and zoonotic transmission to humans. 7 , 9 Alongside the paucity in drug development, 10 these factors necessitate judicious prescribing practices. A transdisciplinary approach to antiparasitic prescription is vital for achieving this goal, providing a broader knowledge base, considering animals, humans and the environment and supports universal health control policy. 7 This approach can enhance understanding of zoonotic disease transmission between animals and humans and reinforces the need for proactive intervention. 7 Responsible veterinary prescribing is a key strategy for mitigating these risks. However, industry‐level change is necessary to yield significant benefits. 11
Despite growing evidence of environmental contamination and the negative effect on the insect population caused by antiparasitic drugs, the Veterinary Medicines Directorate does not currently require environmental safety testing for small animal antiparasitics. 12 , 13 Research has demonstrated that imidacloprid usage contributes to a deficiency in 69% of bioelements essential to honey bee health. 14
Antiparasiticide resistance poses a significant public health threat, and drugs used prophylactically in animals often overlap with those used in human medicine. 7 COVID‐19 increased public awareness of the importance of integrated health policies, shifting perceptions towards One Health principles. 7 Effective antiparasitic control requires attention to environmental hygiene, individualised risk assessment and proper husbandry practices. Communication and education of clients about these factors is integral to antiparasitic stewardship and can significantly improve compliance. 15 , 16 With over 50% of the global population owning pets, incorporating client perspectives into decision making represents an opportunity to provide guidance and education of pet owners on zoonotic risks 16 alongside the environmental impact, a vital component of antiparasitic stewardship.
Antibiotic stewardship programmes have proven effective in reducing overuse and inappropriate prescriptions of antimicrobials, 8 suggesting that similar antiparasitic initiatives could prove beneficial. By analysing veterinary prescribing patterns, these programmes provide a foundation for interventions designed to promote behavioural change, 17 particularly in reducing widespread prophylactic antiparasitic use. 12 Responsible prescription is essential for maintaining long‐term efficacy and mitigating resistance risk and environmental contamination, with antiparasiticides accounting for 39% of veterinary pharmaceutical products. 18
Most studies have focused on the use of antiparasiticides usage in livestock, whereas less is known about their use in companion animals. In this context, the present study specifically addresses their use in cats. To the authors’ knowledge, this study is the first to qualitatively investigate the behavioural drivers underlying antiparasitic prescription for cats in the UK. A survey was created and answered by 16 UK‐based veterinarians. The responders were asked to indicate the extent to which they considered different factors when prescribing antiparasitic for cats, including environmental contamination, local parasite distribution, age of animal ease of administration, animal lifestyle, practice of purchasing preferences, client preferences and risk of parasitic resistance.
METHODS
Participants were recruited via non‐probability convenience sampling through the University of Surrey, School of Veterinary Medicine's partner practice network between 22 February 2024 and 6 March 2024. Royal College of Veterinary Surgeons‐registered veterinary surgeons were invited via an introductory email containing details about the study's objectives and a link to the survey. The inclusion criteria were that participants had prescribed antiparasiticides in the last 4 months preceding the study and that they currently worked in small animal practice. A prize draw was offered as an incentive for participation. Survey data were securely stored within the online survey platform (JISC v3).
The online survey was designed using JISC and structured to investigate factors influencing antiparasitic prescribing behaviour among veterinarians. The survey comprised 29 questions and began with demographic information, including age, gender, county of practice, place of qualification and location of the practice as well as whether they have prescribed antiparasiticides within the last 4 months. Subsequent sections explored prescribing behaviours using a combination of five‐, seven‐ and eight‐point Likert scales and open‐ended free‐text fields to capture qualitative insights.
A pilot study involving four veterinarians was conducted to evaluate the clarity and relevance of the survey items; their responses were excluded from the final dataset. Although the survey included questions related to antiparasitic prescription for both canine and feline patients, data collection and analysis were conducted separately for each species by two independent researchers. The present study focuses solely on prescribing practices for feline patients due to significant differences in lifestyle to canids. Their free roaming nature means that predation is a key route of parasite transmission and significantly increases exposure. 18 , 19
Survey responses were exported from JISC to Microsoft Excel (version 16.81) for data familiarisation and storage. Descriptive statistics were applied to analyse the data, which included percentages for the Likert‐scale questions. The dataset comprised nominal variables, including gender and years of experience in practice, as well as ordinal variables (frequency of antiparasitic prescription for routine prevention, frequency with which individual parasite control plans are made, incorporating risk‐based parasite control, frequency of parasite diagnostic testing, and importance placed on regular diagnostic testing), along with demographic information. The survey is included within the Supporting Information and response to open‐ended questions are mentioned within the ‘Results’ section.
RESULTS
A total of 16 responses were received. All participants were registered small animal veterinary practitioners who met the inclusion criteria. Of these, 11 identified as female, four as male and one preferred not to disclose their gender. Ease of administration, animal lifestyle and practice purchasing preferences governed veterinarians’ antiparasiticide prescription. A high proportion of prescribing veterinarians did not consider the risks of environmental contamination and parasitic resistance in the decision‐making process (Figure 1).
[图：Veterinarians’ perception of factors that influence their prescription of antiparasiticide drugs to cats in clinical pra]
A total of 63% of participants considered prophylactic administration of antiparasiticides to be the most appropriate prescription policy for feline patients. Antiparasitic medication was always prescribed by 25% of respondents and was often prescribed by 69%. Two participants reported that the ‘risk of flea infestation was high’ and that infestation could have significant welfare implications.
Although 32% of participants considered regular parasite diagnostic testing to be moderately or very important, only 6% reported routinely performing pre‐treatment diagnostic testing. The frequency of individualised parasite control plans varied; 13% of respondents always implemented such plans, while the majority did so sometimes (38%) or rarely (25%).
Literature addressing the potential risks of parasiticides, particularly within the One Health framework, was read sometimes by 63% of participants and rarely by 25%. Additionally, 50% of respondents disagreed with the statement: ‘There is sufficient knowledge and understanding about the prevention and control of parasite infections in companion animals’.
Among the antiparasitic products reported, Advocate (imidacloprid and moxidectin) and Droncit (praziquantel) were the most commonly prescribed, cited by 88% and 81% of respondents, respectively, while Milpro was not prescribed by any participant (Table 1).
TABLE 1. Most commonly prescribed antiparasitic medications to cats by small animal veterinarians practicing in the UK ( n = 16).
| Brand name (active ingredient) | Percentage of respondents (%) |
|---|---|
| Milpro (praziquantel and milbemycin oxime) | 0 |
| Other | 6 |
| Stronghold (selamectin and sarolaner) | 6 |
| Broadline (eprinomectin and fipronil) | 6 |
| Nexguard Combo (praziquantel) | 13 |
| Panacur (fenbendazole) | 38 |
| Credilo (lotilaner) | 63 |
| Droncit (praziquantel) | 81 |
| Advocate (imidacloprid and moxidectin) | 88 |
DISCUSSION
This study aimed to explore veterinarians' antiparasiticide prescribing behaviour in small animal practice and to identify key determinants influencing prescription decisions. To date, limited research has focused specifically on feline parasite prophylaxis, despite their high exposure to parasites. 19 The development of effective behavioural interventions depends on clear understanding of prescribing behaviour. 6 This issue is particularly relevant given the increasing awareness of environmental contamination from products containing imidacloprid, 12 fipronil 20 and fluralaner, the latter of which is excreted in faeces for several weeks. 21 While much of the existing research has centred on antibiotic prescription, the principles underlying behavioural intervention are transferable to parasitology. In developed countries, 50% of individuals live with a companion animal, 22 which highlights the significance of veterinarians’ role in parasite control to safeguard human health (especially those potentially at higher risk of disease) and animal welfare.
Pet owners, practice preferences and ease of administration were identified as significant factors influencing antiparasiticide prescription for cats. A total of 95% of participants reported regularly prescribing topical antiparasitic medications. Ease of administration plays a critical role in feline medicine: topical products such as collars, flea spot‐ons and bedding have been identified as sources of contamination. 12 , 13 Further research into the efficacy of alternative control approaches to prophylactic antiparasiticide administration is needed.
Client preferences also influenced veterinarians' product choice. While accommodating owner preferences may enhance compliance, veterinarians should consider the risks of resistance development and environmental contamination. Most research in this area has been conducted within farm and equine medicine, limiting the ability to draw conclusions about the environmental impact of feline antiparasiticides. 23 , 24 Due to current insufficient evidence, the environmental risk posed by antiparasitic treatments is poorly understood and further studies are needed to quantify the levels and characterise the routes of environmental exposure, as well as identify any resulting environmental harm. 18
Without awareness of resistance patterns, it is challenging to implement appropriate mitigation strategies. 22 In the present study, 69% of respondents indicated that local parasite distribution influenced their prescription choices and veterinarians expressed a desire for further training and education in antimicrobial stewardship programmes. Guidelines developed by the European Scientific Counsel for Companion Animal Parasites may be used to aid prescription based on individual risk and reduce ‘the indiscriminate prophylactic use’ of these products. 12 However, the available literature on antiparasitic guidelines and One Health principles was not widely read among participants. This lack of engagement is concerning as it may reflect broader gaps in professional awareness of these issues.
This study is limited by the small sample size of participating veterinarians. The response rate could not be calculated, as the number of veterinarians within each partner practice was unknown. Participants had varying levels of clinical experience, and the extent to which this influenced perceptions of resistance, environmental contamination, or the significance of this topic within a One Health framework remains unclear. Additionally, 11 of the 16 respondents practiced in Kent; therefore, the findings may not be representative of the wider UK veterinary profession. Caution should be exercised when extrapolating these results, given the complexity of decision making in clinical practice. Given the importance of this subject, further studies involving wider respondents not only in the UK but also abroad are urgently needed to enhance One Health stewardship.
CONCLUSION
This study demonstrated that despite environmental contamination and antiparasitic resistance which continue to emerge as critical issues, prioritisation of convenience and client satisfaction was found to be common in veterinary practice. To effectively address these challenges, antiparasitic stewardship strategies must incorporate not only evidence‐based guidelines but also behavioural interventions that target prescribing veterinarians. Veterinarian education may contribute to future strategic parasite control efforts. Further research including larger and international respondent pool is recommended to enhance scientific contribution. The development of an industry‐wide stewardship programme to inform veterinarian decision making may provide benefits in protecting human and animal health and limiting environmental impact.
AUTHOR CONTRIBUTIONS
Rosie Elizabeth Hobbs performed the literature search, data collection and initial writing of the paper. Aneta Duszak‐Kowal was a significant contributor in editing the paper and provided expertise in the topic area. Both the authors agreed upon the final version of the manuscript submitted to the publisher.
CONFLICTS OF INTEREST
The authors declare they have no conflicts of interest.
ETHICS STATEMENT
Ethical approval for this study was obtained from the University of Surrey, School of Veterinary Medicine. No personal or identifiable data were collected, ensuring respondent confidentiality. Informed consent was obtained before survey participation. A prize draw was included to incentivise completion (SageHDR: 1046015‐1045997‐116939968).
INFORMED CONSENT
Informed consent was obtained from all participants prior to their participation in the survey.
Supporting information
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