title: “When Not to Prescribe: What Every Veterinarian Should Know About Antibiotic Stewardship” slug: antimicrobial-stewardship-veterinary-practice date: 2026-02-01 source_lecture: “Lecture 14: Antimicrobial Stewardship” presenter: “Veterinary Pharmacist (Purdue VTH residency)” status: verified word_count: 769

When Not to Prescribe: What Every Veterinarian Should Know About Antibiotic Stewardship

A pushy client walks in on a Friday afternoon. Her dog has been urinating more frequently for three days. She is certain it is a UTI and wants the same antibiotic that “worked last time.” She has plans this weekend and wants a prescription now.

You suspect she may be right. But should you prescribe?

This scenario, presented during a VetOnIt CE lecture by a veterinary pharmacist with eight years of experience in veterinary teaching hospitals, captures a tension every practitioner knows: client satisfaction vs. responsible prescribing. And the stakes are higher than the exam room.

The Numbers Behind Resistance

In 2019, antibiotic resistance was directly responsible for an estimated 1.27 million deaths worldwide, with nearly 5 million additional deaths associated with drug-resistant infections.^1^ If current trends continue, projections estimate that by 2050, 10 million people could die annually from infections that were once treatable.^2^

This is not a distant, abstract threat. The presenter emphasized that drug development has not kept pace with resistance. From 1980 to 2000, dozens of new antibiotics reached the market. Since 2000, the presenter reports, fewer than 20 have been approved, and only four introduced novel mechanisms of action. The World Health Organization’s 2021 pipeline analysis confirmed that the global antibiotic pipeline remains insufficient, particularly against extensively drug-resistant gram-negative bacteria.^3^

And veterinary medicine shares responsibility. One study at a veterinary teaching hospital found that nearly 40% of canine antibiotic prescriptions had no documented evidence of infection.^4^ If this occurs in academic settings with the highest standards of oversight, the implications for private practice deserve attention.

Right Drug, Right Time, Right Reason

Antimicrobial stewardship is not about refusing to treat. It is about using the right antibiotic at the right time, at the right dose, for the right duration. The presenter outlined a framework built on three pillars:

Diagnostic confirmation. Move beyond nonspecific symptom clusters. A collection of vague signs does not justify an antibiotic. Pursue a preliminary diagnosis before reaching for the prescription pad.

Culture and sensitivity testing. C&S data helps identify the narrowest spectrum antibiotic that will work. Without it, practitioners default to broad-spectrum agents, which accelerates resistance. The ISCAID guidelines for diagnosis and management of bacterial urinary tract infections in dogs and cats recommend C&S testing before prescribing for both sporadic and recurrent bacterial cystitis in stable patients.^5^

Documentation of rationale. Why did you choose an antibiotic? Why this one? Recording your reasoning creates accountability and supports stewardship audits.

Back to Friday Afternoon

In the case study, the veterinarian performs a cystocentesis. The in-house urinalysis shows white blood cells and rods. Bacteria are present, but the patient is stable, has no systemic signs, and has not had a UTI in 18 months.

The guidelines are clear: wait for C&S results. Start a narrow-spectrum drug like amoxicillin if you must begin treatment, then adjust based on results. Do not default to a fluoroquinolone (which the World Health Organization classifies as critically important for human medicine) simply because it is what the client requests.

The presenter acknowledged the real-world difficulty. What happens when you hold firm on Monday, but your associate writes the prescription the client wanted? That inconsistency breeds client complaints and undermines trust. This is why practice-wide conversations about stewardship matter.

What You Can Do Monday Morning

The presenter recommended several practical next steps:

1. Identify the top five reasons you prescribe antibiotics in your practice and pull the relevant guidelines.
2. Discuss prescribing approaches with all clinicians in your practice. You may not reach consensus, but awareness of differences prevents client-facing conflicts.
3. Track how often you obtain C&S data. If it rarely happens, consider whether you can make a stronger case to clients about why the investment is worthwhile.
4. Review resources from the University of Minnesota’s antimicrobial stewardship program (free to access), the ISCAID guidelines, and FDA guidance documents 209 and 213 on medically important antibiotics in food animals.

Several veterinary teaching hospitals, including Ohio State, Texas A&M, and Illinois, have recently implemented antimicrobial stewardship committees. The presenter notes that many others have begun developing restricted-use lists for antibiotics classified as critically important by the WHO.

The Bigger Picture

Every antibiotic prescription is a decision that extends beyond the patient in front of you. Resistant bacteria do not respect species boundaries. The choice between client convenience and responsible prescribing is not always comfortable, but stewardship is not about perfection. It is about intentionality.

Hear the full case discussion and stewardship framework in the complete lecture, available on demand.

Watch Now

References

1. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-655. PMID: 35065702.
2. O’Neill J. Tackling drug-resistant infections globally: final report and recommendations. Review on Antimicrobial Resistance. 2016.
3. World Health Organization. 2021 Antibacterial agents in clinical and preclinical development: an overview and analysis. WHO; 2022.
4. Wayne A, McCarthy R, Lindenmayer J. Therapeutic antibiotic use patterns in dogs: observations from a veterinary teaching hospital. J Small Anim Pract. 2011;52(6):310-318. PMID: 21627659.
5. Weese JS, Blondeau J, Boothe D, et al. International Society for Companion Animal Infectious Diseases (ISCAID) guidelines for the diagnosis and management of bacterial urinary tract infections in dogs and cats. Vet J. 2019;247:8-25. PMID: 30971357.