Your Practice Tomorrow: Practical Steps for Antimicrobial Stewardship Implementation
Transforming stewardship from theory to daily practice in veterinary medicine
Antimicrobial stewardship often feels like an overwhelming concept — one more demand on busy veterinary practices already stretched thin. But implementation doesn’t require a complete practice overhaul. As Dr. Lauren Forsythe explains, “What exactly an antimicrobial stewardship program looks like will vary from practice to practice. There’s no one-size-fits-all.”
The key is starting with practical, achievable steps that build momentum toward comprehensive stewardship. Research demonstrates that 135 general practice veterinary clinics successfully implemented stewardship programs¹, proving that effective antimicrobial stewardship is achievable across diverse practice settings.
The Foundation: Start with Documentation
Before changing prescribing patterns, understand your current practices. Dr. Forsythe emphasizes the importance of “documenting your treatment rationale. Why did you decide to use an antibiotic? What led you to that decision? And what led you to choosing the one you did?”
Week 1-2: Audit Current Prescribing
- Track the five most commonly prescribed antibiotics
- Document indication for each prescription
- Note whether culture and sensitivity testing was performed
- Record treatment duration and outcomes
This baseline data reveals patterns you can’t address until you see them clearly.
Essential Framework Implementation
Dr. Forsythe outlines the core stewardship principle: “Using the right antibiotic at the right time, the right dose, and for the right duration.” This translates into four practical checkpoints for every antibiotic decision:
Diagnostic Confirmation Move beyond symptom-based prescribing. Before reaching for antibiotics, ask: “Do I have evidence of bacterial infection, or am I treating clinical signs that could have multiple causes?”
Culture and Sensitivity Testing Identify which cases truly require immediate empirical therapy versus those where waiting 48-72 hours for culture results won’t compromise patient outcomes.
Local Resistance Patterns Contact your state veterinary school or diagnostic laboratory to inquire about local antibiograms — data showing common pathogens and their susceptibility patterns in your geographic area.
Treatment Rationale Documentation Record not just what antibiotic was prescribed, but why that specific choice was made. This builds institutional knowledge and enables quality improvement.
Month 1: Establish Practice Guidelines
Focus on the three most common infections your practice treats. For many small animal practices, this includes:
- Urinary tract infections
- Skin and soft tissue infections
- Post-surgical prophylaxis
For each condition, establish simple protocols based on current guidelines. Dr. Forsythe recommends starting with available guidelines: “Review the guidelines that are available when you commonly treat conditions with antibiotics in your practice.”
UTI Example Protocol:
- Cystocentesis for urinalysis and culture
- First-line therapy: amoxicillin for 3-5 days
- Adjust based on culture results if no improvement
- Reserve broad-spectrum antibiotics for complicated cases
Month 2: Team Alignment
Inconsistent prescribing within practices undermines stewardship efforts. Dr. Forsythe notes the importance of discussing “infection treatment approaches with all the clinicians in your practice. You might not always agree, but being aware of what other doctors in your practice do is key to addressing client concerns.”
When clients learn that different veterinarians have different prescribing patterns, they begin “doctor shopping” for their preferred approach.
Practice-Wide Alignment Strategies:
- Monthly case discussions featuring common infectious diseases
- Shared protocols accessible to all veterinarians
- Regular review of culture and sensitivity results
- Client communication strategies about stewardship principles
Month 3: Client Education Integration
Proactive client education prevents many stewardship challenges. Rather than defending diagnostic testing after clients resist it, incorporate stewardship explanations into routine communications.
Sample Client Conversation: “I’d like to test the urine to identify exactly which bacteria we’re dealing with and which antibiotics will be most effective. This helps us choose the best treatment for your pet and also helps preserve antibiotic effectiveness for other animals and people.”
Technology Tools and Resources
Dr. Forsythe recommends several practical resources:
University of Minnesota Stewardship Initiative: Provides free clinical resources, practice handbooks, and implementation guides specifically for veterinary settings.
Guidelines Access: Make current guidelines for common conditions readily available to all practice veterinarians.
Diagnostic Laboratory Partnerships: Establish relationships that facilitate rapid culture and sensitivity testing.
Measuring Success
Track simple metrics that demonstrate progress:
- Percentage of cases where culture testing was performed
- Frequency of narrow-spectrum versus broad-spectrum antibiotic use
- Treatment failure rates requiring antibiotic changes
- Client satisfaction with explanations of stewardship approaches
The Teaching Hospital Model
Academic institutions are leading stewardship implementation. Dr. Forsythe notes that “Ohio State, Texas A&M, Illinois, and I know several others have implemented antimicrobial stewardship committees” with restrictions on high-priority antibiotics requiring additional approvals.
While community practices may not need formal committees, the principle applies: establish checkpoints for critically important antibiotics like fluoroquinolones and third-generation cephalosporins.
Starting Tomorrow
Antimicrobial stewardship begins with the next prescription decision. The question isn’t whether your practice can afford to implement stewardship — it’s whether you can afford not to.
Every step toward appropriate antibiotic use helps preserve these critical medications for future patients. Start small, build gradually, and remember that perfect stewardship isn’t required on day one. Progress is.
Ready to implement evidence-based stewardship strategies in your practice? Learn from experts who’ve successfully transformed prescribing patterns in real-world settings.
Register for Event 33: Advanced Antimicrobial Stewardship →
References
- Hardefeldt LY, et al. Antimicrobial stewardship in companion animal practice: an implementation trial in 135 general practice veterinary clinics. JAC Antimicrob Resist. 2022;4(1):dlac015.