How do I implement an antimicrobial stewardship program in a small animal practice to reduce resistance?

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A functional small animal antimicrobial stewardship (AS) program rests on four sequential pillars: commitment and leadership, diagnostic culture, protocol development, and ongoing measurement with feedback. Start with a formal commitment from practice leadership. The AVMA defines veterinary AS 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." 6710 The AAFP/AAHA Antimicrobial Stewardship Guidelines and the AVMA core principles provide the foundational framework for companion animal practices. 124 Designating a specific AS leader within the practice is essential — this person drives protocol development, educates team members, and guides staff to continuing education resources on antimicrobial resistance. 9 Increase diagnostic testing before prescribing. Underutilization of culture and susceptibility (C&S) testing is a primary driver of "just-in-case" antimicrobial prescribing in small animal practice, with cost cited as the most frequent barrier. 2 A downstream consequence of low C&S submission rates is that local antibiograms become biased, leading to inappropriate empiric drug selection. 2 Practices should track how often C&S testing is performed as a stewardship metric and build client communication strategies that address cost concerns proactively. 9 Identify conditions where antimicrobials are not indicated and build explicit protocols around them. The AAFP/AAHA guidelines specify clinical conditions for which antimicrobials are generally unnecessary, including upper respiratory infections, pancreatitis, lower urinary tract disease, dental prophylaxis and tooth extractions, and acute diarrhea. 212 Protocols should compare current prescribing practices against published guidelines and consensus statements, identify obstacles such as client press