Responsible antibiotic use in veterinary practice: why and how

It is easy to perceive responsible use as an external constraint, made of registers and obligations. In reality stewardship coincides with good medicine: an antibiotic prescribed without indication does not help the patient, exposes it to adverse effects and disrupts the microbiota, as well as favouring the selection of resistant strains. Reasoning in terms of appropriateness therefore means treating the individual animal better and, at the same time, preserving the effectiveness of drugs that may be needed in future by that patient, by other animals and by people.

This grid does not replace the reference guidelines, which remain the anchor for specific choices, but it offers a repeatable mental path that makes explicit decisions often taken on autopilot. Its value lies precisely in making them conscious, especially in high-pressure situations where the shortcut of an easy prescription is most tempting.

The first lever of stewardship is the hardest: resisting the prescription when it is not indicated. Many requests arise from client expectations, time pressure or diagnostic uncertainty, and the right answer is not always a drug. When the antibiotic is needed, the choice of molecule should be as targeted as possible, reserving classes considered critically important for cases where no reasonable alternatives exist.

1. 1

   Form a diagnostic hypothesis before the drug

   Base the decision on history, clinical examination and, where useful, tests. Prescribing before reasoning about the suspicion leads to broad and often needless coverage.

2. 2

   Use diagnostics when they change the decision

   Culture and sensitivity, cytology and other tests are valuable especially in recurrent, complicated or unresponsive infections, where they steer a targeted choice.

3. 3

   Prefer the narrowest effective spectrum

   For equal expected efficacy, choose the more targeted molecule and reserve critical classes for cases where they are truly necessary, following the guidelines.

4. 4

   Set dose, route and duration explicitly

   Avoid underdosing and habitual, unjustified durations. Adapt the plan to the current weight and the patient's condition and put it in writing.

5. 5

   Schedule the reassessment

   Set when and how to recheck the animal, so you can confirm, stop or correct the therapy instead of prolonging it by inertia.

An important part of stewardship plays out in the relationship with the owner. Many inappropriate prescriptions arise from the perception that an antibiotic is always necessary and that a visit without a drug is an incomplete visit. Explaining why in a given case the antibiotic is not needed, or why a specific one was chosen, takes time but builds trust and reduces improper requests over time.

• Explain simply when an antibiotic does not help, for instance in many viral or self-limiting conditions, while still offering a symptom management plan.
• Clarify the importance of completing the therapy as prescribed and of not keeping or reusing leftovers for future episodes.
• Warn against using leftover antibiotics from previous courses or ones taken from other animals, a dangerous and common practice.
• Provide written instructions with dose, timing, duration and what to do about a missed dose or adverse effects.
• Agree on a reassessment and explain which signs should bring the animal back to the clinic sooner than planned.
• Recall the measures that reduce the need for antibiotics, such as prevention, hygiene and regular check-ups.

Investing in this communication has a cumulative effect: a client who has understood why they did not receive an antibiotic in one case is less inclined to demand it the next time. In this sense every consultation is also a chance for health education that reaches beyond the individual animal.

Even the most correct prescription fails if the therapy is not followed well. Early stoppage, missed doses and difficulty administering the drug are frequent causes of failure and relapse, which in turn push toward new prescriptions and toward resistance. Supporting adherence is therefore an integral part of stewardship, not an afterthought.

Responsible antibiotic use takes root when it becomes a culture shared across the whole practice, not an isolated initiative. Internal protocols, continuing education and moments to discuss difficult cases help make good practice the norm rather than the exception, and support the individual clinician in moments of pressure.

1. Adopt shared internal protocols, aligned with the reference guidelines, for the most common conditions.
2. Set aside regular time to review prescriptions and discuss complex cases as a team.
3. Standardise the messages to the client, so all staff convey the same guidance on correct use.
4. Invest in supporting diagnostics and in prevention, which reduce the need for antimicrobials upstream.
5. Keep training up to date, because guidelines and knowledge about resistance evolve over time.
6. Frame stewardship as a mark of the clinic's quality toward clients too, not as a limit on service.

The goal is not to prescribe the fewest possible antibiotics in absolute terms, but to prescribe them when they are needed, in the right way, and not to prescribe them when they are not. It is a responsibility the vet shares with human medicine and public health, and it is exercised one clinical decision at a time.