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Pharmaceuticals2026-06-08 · 12 min read

Antimicrobial Stewardship in Veterinary Practice: Building a Clinic Antibiotic Program

How to implement an antimicrobial stewardship program in a veterinary clinic using AVMA core principles — committee setup, prescribing protocols, culture-first workflows, and audit strategies.

Ran Chen
Ran Chen
Founder, VetMedGuide. Life-sciences operator and 10× global market-access lead.
Published

Antimicrobial resistance (AMR) is one of the most consequential challenges in both human and veterinary medicine. The CDC estimates that up to 50% of antimicrobial use in some healthcare settings is inappropriate — and there is growing evidence that a similar pattern exists in companion animal practice. For veterinary clinics, antimicrobial stewardship (AMS) is no longer optional. It is a professional responsibility, a regulatory expectation, and increasingly, a differentiator that clients notice.

This article walks through how to build a practical antimicrobial stewardship program in a general practice setting — using the AVMA's five core principles as the framework, with specific implementation steps that real clinics have used.

What antimicrobial stewardship means in veterinary medicine

The AVMA defines antimicrobial stewardship 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."

This is not about never using antibiotics. It is about using them when they are genuinely needed, at the right dose, for the right duration, and with the narrowest effective spectrum — while relying on prevention, diagnostics, and supportive care to reduce unnecessary prescriptions.

The concept applies across all practice types, but implementation looks different in a companion animal GP compared with a large-animal or mixed practice. This article focuses on small-animal general practice.

The AVMA's five core principles

The AVMA Committee on Antimicrobials established five core principles that every veterinary practice can use to build its stewardship program. These are modeled on the CDC's core elements that have been successfully deployed in human healthcare:

  1. Commit to stewardship
  2. Advocate for a system of care to prevent common diseases
  3. Select and use antimicrobial drugs judiciously
  4. Evaluate antimicrobial drug use practices
  5. Educate and build expertise

Each principle translates into specific, actionable steps. The University of Minnesota's Antimicrobial Resistance and Stewardship Initiative (ARSI) has developed a comprehensive handbook that maps implementation strategies to each principle — a resource referenced throughout this article.

Step 1: Commit to stewardship — build the infrastructure

Form an antimicrobial stewardship committee (ASC)

Even in a small practice, designate a small team — ideally a veterinarian (the "stewardship champion"), a credentialed technician, and a practice manager. The champion drives the program, but shared ownership prevents it from becoming one person's project that dies when they leave.

Make a visible commitment

Post a stewardship commitment statement in the pharmacy area, treatment room, or staff break room — similar to the CDC's "Commitment Poster" model used in human clinics. This signals to the team and to clients that the practice takes antibiotic use seriously.

Define priority areas

Don't try to fix everything at once. Pick one or two high-impact conditions where antibiotic prescribing is common and evidence suggests overuse. For most small-animal GPs, the top targets are:

  • Canine superficial bacterial pyoderma — often treated empirically when cytology could distinguish true infection from other causes.
  • Feline upper respiratory infections — most are viral, yet antibiotics are frequently prescribed.
  • Canine acute diarrhea — typically self-limiting, but broad-spectrum antibiotics are sometimes used preemptively.
  • Post-dental prophylaxis — guidelines suggest antibiotics are not needed for routine cleanings without extractions, yet prescribing patterns vary.

Set measurable goals

Example goals: "Reduce empiric antibiotic prescriptions for superficial pyoderma by 30% over six months by requiring cytology before first-line antimicrobial therapy" or "Achieve culture-and-sensitivity testing on 80% of complicated UTI cases."

Step 2: Prevent disease — reduce the need for antibiotics

Stewardship starts before the prescription pad. Preventing common infections eliminates the need for antimicrobial treatment entirely.

Vaccination

Ensure core vaccines (rabies, DHPP for dogs; FVRCP for cats) are current for every patient. For dogs in high-exposure environments (daycare, boarding, dog parks), discuss lifestyle vaccines like Bordetella, canine influenza, and leptospirosis. For cats with outdoor access, FeLV vaccination should be part of the conversation.

Dental care

Periodontal disease is one of the most common conditions in small-animal practice and a frequent driver of antibiotic prescriptions. Proactive dental care — including routine COHAT (comprehensive oral health assessment and treatment) under anesthesia — reduces the incidence of advanced dental infections that require antimicrobial therapy.

Client education on prevention

  • Flea and tick prevention to reduce secondary bacterial skin infections.
  • Weight management to reduce interdigital pyoderma and skin fold dermatitis.
  • Environmental management for atopic dogs — reducing allergen exposure decreases secondary infections that get treated with antibiotics.
  • Litter box management for cats to reduce feline lower urinary tract signs that may be inappropriately treated with antibiotics.

Infection control in the hospital

Hospital-acquired infections are a real concern. Basic practices that reduce nosocomial spread:

  • Hand hygiene between every patient.
  • Proper cleaning and disinfection of examination tables, equipment, and kennels.
  • Isolation protocols for patients with known or suspected infectious disease.
  • Cleaning endotracheal tubes and laryngoscope blades between patients.

Step 3: Select and use antimicrobial drugs judiciously

This is the principle that most directly changes prescribing behavior.

Culture before treating (when feasible)

The single most impactful stewardship action a practice can take is to require cytology or culture before prescribing antibiotics for common conditions where the diagnosis is uncertain.

For canine pyoderma: surface cytology (tape prep, impression smear) takes minutes and distinguishes bacterial infection from yeast overgrowth, Malassezia, or non-infectious dermatitis. The results change the treatment plan a substantial percentage of the time.

For UTIs: urine culture and susceptibility testing before starting antibiotics (or at minimum, urinalysis with sediment review) should be standard for any first UTI in a cat, recurrent UTIs in either species, or cases with complicating factors.

For wound infections: aerobic culture before starting antibiotics, particularly for bite wounds, surgical site infections, or non-healing wounds.

Use spectrum-appropriate therapy

When antibiotics are needed, start with the narrowest effective spectrum:

  • First-generation cephalosporins (cephalexin) for uncomplicated superficial pyoderma — not fluoroquinolones.
  • Amoxicillin or amoxicillin-clavulanate as appropriate first-line choices for soft tissue infections.
  • Reserve fluoroquinolones (enrofloxacin, marbofloxacin, orbifloxacin) for culture-confirmed infections where susceptibility data supports their use, or for serious infections where Gram-negative coverage is essential.
  • Reserve carbapenems and other last-resort antibiotics for documented multidrug-resistant infections with susceptibility confirmation — and only after consultation with a veterinary infectious disease specialist when possible.

Duration: treat for the right length of time

Evidence continues to support shorter courses for many common infections. The historical default of 14–21 days of antibiotics for skin infections is being challenged by data showing that clinical cure often occurs sooner. The ISCAID (International Society for Companion Animal Infectious Diseases) guidelines, while focused on specific conditions, generally recommend treatment durations based on clinical response rather than fixed calendar intervals.

Key practice: recheck the patient at the end of the initial course. If resolved, stop. Do not automatically extend for a "buffer" period.

Avoid antibiotics when they are not indicated

Conditions where antibiotics are commonly prescribed but often unnecessary:

  • Acute hemorrhagic diarrhea syndrome (AHDS) in dogs — typically not bacterial in origin; supportive care is the mainstay.
  • Feline upper respiratory infection — most are viral (FHV-1, FCV). Antibiotics should be reserved for cases with documented secondary bacterial infection (mucopurulent nasal discharge, fever, lethargy beyond expected viral course).
  • Pancreatitis — sterile inflammation; antibiotics only if there is evidence of septic complications.
  • Routine dental cleanings without extractions — AAHA guidelines do not recommend prophylactic antibiotics for cleanings in healthy patients.

Step 4: Evaluate — track what your practice actually prescribes

You cannot improve what you do not measure. Audit prescribing practices regularly.

Medication inventory audit

Start with a simple inventory of antimicrobials stocked in the clinic. Which antibiotics are on formulary? Are there broad-spectrum agents stocked that rarely have a documented indication? This exercise alone often reveals opportunities to tighten the formulary.

Prescribing record review

Audit a sample of medical records for antibiotic prescriptions. For each, document:

  • Indication (was there a documented diagnosis?)
  • Was cytology or culture performed before prescribing?
  • Drug selected and spectrum
  • Dose, duration, and route
  • Outcome documented at recheck

This can be done manually for small practices or extracted from PIMS reporting for larger hospitals. The goal is not to police individual prescribers but to identify systemic patterns — for example, finding that 70% of feline URI cases receive antibiotics when guidelines suggest only 10–15% have bacterial complications.

Clinic antibiogram

A clinic-specific antibiogram — a summary of organism-specific susceptibility patterns compiled from your own culture results — is a powerful stewardship tool. It tells you which antibiotics are most likely to be effective against the bacteria commonly seen in your patient population, allowing you to make better empirical choices while waiting for culture results.

Building an antibiogram requires compiling at least 30–50 isolates per organism, which takes time in a single practice. Multi-location practices or those that work with a single reference lab may be able to generate one more quickly. Ohio State University's Antimicrobial Stewardship Program provides guidance on antibiogram construction.

Step 5: Educate — train the team and inform clients

Stewardship programs fail when only veterinarians are engaged. Technicians, assistants, and front-desk staff all play roles in the prescribing ecosystem.

All-staff training

  • Annual (or more frequent) training on AMR and stewardship principles.
  • Condition-specific prescribing protocols posted in the treatment area.
  • Case-based discussions at staff meetings — reviewing real cases where antibiotics were or were not the right choice.

Client communication

Clients often expect antibiotics. Setting expectations requires specific communication skills:

  • "The cytology shows yeast, not bacteria — so an antifungal is the right treatment, not an antibiotic."
  • "Most upper respiratory infections in cats are viral and resolve on their own. Here's what to watch for that would indicate we need to reconsider antibiotics."
  • "Your dog's diarrhea is likely from dietary indiscretion, not an infection. Antibiotics won't help and could make it worse."

Provide written client handouts explaining common conditions and why antibiotics may not be needed. The AVMA and AAFP/AAHA have developed client-facing materials.

Safe medication disposal

Include information about safe disposal of unused antibiotics in every dispensing interaction. Leftover antibiotics in the home are a well-documented source of inappropriate self-administration (by both humans and pets), contributing to resistance.

The regulatory backdrop: why stewardship matters beyond the clinic

Antimicrobial stewardship in veterinary medicine is not purely voluntary. The regulatory environment has been tightening globally:

  • FDA Guidance for Industry #263 transitioned all remaining over-the-counter medically important antimicrobials to prescription-only status in the United States, effective June 2023. This means veterinary oversight is now required for virtually all antibiotic use in animals.
  • The EU has prohibited the routine preventive use of antibiotics in livestock, restricted metaphylactic use, and encouraged member states to collect species-specific antimicrobial consumption data.
  • Australia, Canada, and the UK have implemented national AMR strategies that include veterinary antimicrobial use monitoring.

Globally, the concept of "One Health" — recognizing that human, animal, and environmental health are interconnected — has become the organizing framework for AMR policy. The FDA CVM, CDC, and USDA all support One Health approaches to antimicrobial stewardship.

For practices that work with international clients, supply veterinary products across borders, or serve populations that include animals imported from other regions, understanding how different countries regulate veterinary antimicrobial use is increasingly relevant. South Korea's MFDS, for example, has implemented a positive-list system for veterinary drug MRLs (maximum residue limits) in food products and has been actively revising equivalence test standards for generics and biosimilars in 2026. The South Korea veterinary drug and medical device regulatory guidance at KoreaMedGlobal covers MFDS registration pathways, Korean market-entry requirements, and the regulatory framework that governs how veterinary pharmaceuticals are approved and monitored in that market.

Getting started: a practical timeline

For a practice starting from scratch, a realistic implementation timeline looks like this:

Month 1: Commit

  • Designate a stewardship champion.
  • Form a small ASC (2–3 people).
  • Post a commitment statement.
  • Complete a formulary inventory.

Month 2–3: Establish protocols

  • Select one priority condition (e.g., canine pyoderma or feline URI).
  • Write a prescribing protocol for that condition.
  • Train the team on the protocol.
  • Begin requiring cytology before first-line antibiotic therapy for the selected condition.

Month 4–6: Measure and refine

  • Audit prescribing records for the priority condition.
  • Compare pre- and post-intervention antibiotic prescription rates.
  • Review outcomes — are patients doing as well or better with more targeted therapy?
  • Add a second priority condition if the first protocol is working.

Month 7–12: Expand

  • Develop protocols for additional conditions.
  • Begin building a clinic antibiogram.
  • Integrate stewardship metrics into regular practice KPI reviews.
  • Consider applying for AAFP/AAHA stewardship recognition if available in your region.

The bottom line

Antimicrobial stewardship is not about restricting access to necessary treatment. It is about ensuring that the antibiotics we have today remain effective for the patients who need them tomorrow. Every veterinary practice — regardless of size, species focus, or practice type — can take meaningful steps to improve how antimicrobials are used.

The tools exist. The guidelines are published. The regulatory direction is clear. What remains is the practice-level commitment to start.

Sources

Topics
Antibiotics & Anti-InfectivesDrug Safety & ToxicologyClinic Workflow & Operations
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