A functional small animal antimicrobial stewardship (AS) program rests on four sequential pillars: commitment and leadership, diagnostic culture, protocol development, and ongoing measurement with feedback.
Start with a formal commitment from practice leadership. The AVMA defines veterinary AS as "the actions veterinarians take individually and as a profession to preserve the effectiveness and availability of antimicrobial drugs through conscientious oversight and responsible medical decision-making while safeguarding animal, public, and environmental health." Journal of the…+2 The AAFP/AAHA Antimicrobial Stewardship Guidelines and the AVMA core principles provide the foundational framework for companion animal practices. AAHA Clinical G…+1 Designating a specific AS leader within the practice is essential — this person drives protocol development, educates team members, and guides staff to continuing education resources on antimicrobial resistance. Journal of the…
Increase diagnostic testing before prescribing. Underutilization of culture and susceptibility (C&S) testing is a primary driver of "just-in-case" antimicrobial prescribing in small animal practice, with cost cited as the most frequent barrier. Journal of the… A downstream consequence of low C&S submission rates is that local antibiograms become biased, leading to inappropriate empiric drug selection. Journal of the… Practices should track how often C&S testing is performed as a stewardship metric and build client communication strategies that address cost concerns proactively. Journal of the…
Identify conditions where antimicrobials are not indicated and build explicit protocols around them. The AAFP/AAHA guidelines specify clinical conditions for which antimicrobials are generally unnecessary, including upper respiratory infections, pancreatitis, lower urinary tract disease, dental prophylaxis and tooth extractions, and acute diarrhea. Journal of the…+1 Protocols should compare current prescribing practices against published guidelines and consensus statements, identify obstacles such as client pressure or cost of diagnostics, and define how the practice will address each barrier. Journal of the…
Measure antimicrobial use and feed data back to the team. Baseline measurement is a prerequisite for improvement — antibiotic use data describe current practices, identify opportunities, guide goal setting, and track progress. Journal of Vete… Stewardship indicators worth tracking include prescription frequency, C&S submission rates, types and frequency of resistant organisms identified, and incidence of adverse effects from antimicrobial use. Journal of the… Formal discussion of AS guidelines with prescribers produces measurable changes in prescribing behavior: after a structured AS intervention in a multi-site small animal practice, cefovecin prescribing to cats dropped by 22.3% and metronidazole prescribing to dogs dropped by 41.6% immediately post-intervention. Journal of Vete… Importantly, that intervention shifted antimicrobial choice more than it reduced overall prescription frequency, suggesting that AS education should focus specifically on appropriate drug selection rather than simply reducing prescription rates. Journal of Vete…
Extend stewardship beyond the prescription pad. Preventive medicine practices — vaccination, nutrition, and husbandry — reduce the need for antimicrobials and are considered integral components of a complete AS program. Journal of the… Client education, including breeders and pet store owners, is critical for compliance; veterinarians should be aware that each party (clinician and client) tends to attribute prescribing pressure to the other, and communication plans should account for this mismatch. Journal of the…
The greatest institutional barriers to AS program advancement are lack of resources and training. The 2023 Small Animal AS Workshop identified these as the top obstacles across 23 US veterinary schools, and recommended creating program standards and a development road map. Journal of the… Establishing necessary treatment durations was identified as the highest research priority. Journal of the… Practices should treat their AS plan as a continuous improvement process, revisiting protocols as new guidelines are released. Journal of the…
Would you like guidance on which specific drug classes or clinical conditions to prioritize first when auditing your current prescribing patterns?