The Hidden Epidemic: Common Antibiotic Prescribing Mistakes That Fuel Resistance
Even at veterinary teaching hospitals, 38% of antibiotic prescriptions lack evidence of infection
It’s Friday afternoon. A demanding client insists their dog has a UTI and wants the same antibiotic that “worked last time.” No culture was done previously. The client has weekend plans and won’t accept waiting for diagnostic results. Sound familiar?
This scenario, detailed by veterinary pharmacist Dr. Lauren Forsythe, illustrates how routine clinical pressures lead to prescribing decisions that accelerate antimicrobial resistance. But the problem runs deeper than difficult clients — it’s embedded in prescribing patterns across veterinary medicine.
The Teaching Hospital Reality
Consider this alarming statistic: at a veterinary teaching hospital — supposedly representing the pinnacle of evidence-based practice — 38% of therapeutic antibiotic prescriptions had no documented evidence of infection¹. If our academic institutions struggle with appropriate prescribing, what’s happening in busy community practices?
Dr. Forsythe emphasizes this concerning trend: “Using antibiotics as a ‘it might work, it won’t hurt, it’ll make someone feel better that they think they got a drug’ — that strategy is just going to promote resistance.”
This “it can’t hurt” mentality represents perhaps the most dangerous mistake in veterinary prescribing today.
The Most Common Prescribing Traps
Symptom-Based Prescribing Too often, antibiotics become the default response to inflammation, fever, or general illness. Dr. Forsythe notes the importance of moving beyond “well, we’ve got this collection of non-specific symptoms and it could be an infection or it could be any of these other three things. Let’s throw an antibiotic at it and see if it gets better.”
Skipping Culture and Sensitivity Testing Financial constraints and time pressures frequently lead to empirical therapy without diagnostic confirmation. While sometimes necessary in critical cases, this approach often continues inappropriately for stable patients where waiting 2-3 days for results wouldn’t compromise outcomes.
Broad-Spectrum as First Choice When uncertain about the pathogen, many veterinarians reflexively reach for broad-spectrum antibiotics. However, Dr. Forsythe advocates for starting with narrower-spectrum options like amoxicillin when appropriate, then adjusting based on culture results if needed.
Client Pressure Capitulation The Friday afternoon UTI scenario represents a broader pattern where client demands override clinical judgment. Dr. Forsythe acknowledges this challenge: “Is the client battle really worth it?” But she emphasizes the broader implications of every prescribing decision.
The Knowledge Gap Problem
Part of the challenge stems from veterinary medicine’s guideline landscape. As Dr. Forsythe explains, “Veterinary medicine, we have guidelines for quite a few different types of conditions, but there’s also plenty we don’t have guidelines on and there’s not universal agreement that the guidelines really reflect the best options in practice.”
This ambiguity creates inconsistency within practices. When one associate readily prescribes broad-spectrum antibiotics while another follows stricter stewardship protocols, clients learn to “shop” for their preferred approach — undermining stewardship efforts.
The Documentation Deficit
Poor record-keeping compounds prescribing mistakes. When treatment rationale isn’t documented, patterns of inappropriate use remain hidden. Practices can’t improve stewardship without understanding their current prescribing patterns.
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?”
Breaking the Cycle
Addressing these mistakes requires systematic changes:
Establish Practice Guidelines: Even without universal veterinary guidelines, individual practices can establish protocols for common conditions like UTIs, skin infections, and post-surgical prophylaxis.
Track Prescribing Patterns: Regular review of which antibiotics are prescribed most frequently and how often culture data supports those choices reveals opportunities for improvement.
Client Education: Proactive conversations about antimicrobial stewardship help clients understand why diagnostic testing and appropriate antibiotic selection matter beyond their individual pet.
Team Consistency: All veterinarians in a practice should align on stewardship approaches to prevent “doctor shopping” by clients.
The Stakes Keep Rising
These prescribing mistakes aren’t just academic concerns — they directly contribute to the development of resistant bacteria that affect both animal and human health. Every inappropriate prescription provides selective pressure that favors resistant organisms.
The teaching hospital data proves that even in optimal environments with access to specialists and diagnostic resources, inappropriate prescribing remains common. This suggests the problem is systemic, not just a result of resource constraints.
Recognition is the first step toward improvement. By acknowledging these common mistakes and implementing systematic approaches to stewardship, veterinary practices can help preserve antibiotic effectiveness for future generations.
Learn evidence-based approaches to antibiotic stewardship and avoid common prescribing pitfalls. Join leading experts discussing practical stewardship strategies.
Register for Event 33: Advanced Antimicrobial Stewardship →
References
- Wayne A, et al. Therapeutic antibiotic use patterns in dogs: observations from a veterinary teaching hospital. J Small Anim Pract. 2011;52(6):310-8.