Understanding knowledge, attitudes, and practices regarding antimicrobial use and compliance with prescriptions among pig farmers in Japan.

Inappropriate or unnecessary use of antimicrobials accelerates the emergence and dissemination of antimicrobial resistance. Veterinary prescriptions are a key mechanism for providing guidance regarding the appropriate use of antimicrobials from veterinarians to farmers. Because swine sectors consume the largest amount of veterinary antimicrobials in Japan, ensuring prudent use is an urgent priority. Therefore, this study aimed to evaluate pig farmers' compliance with prescriptions and identify their decision-making processes related to prescribed antimicrobial use to explore effective interventions for improving this compliance. We conducted a cross-sectional knowledge, attitudes, and practices (KAP) study among 1,314 pig farmers between December 2023 and February 2024 to evaluate how practices regarding the appropriateness of antimicrobial use and compliance with prescriptions were affected by their knowledge and attitudes. A total of 266 (20.2%) responses were included in our analysis. Although 97.7% of the farmers always complied with the withdrawal period in practice, 6.8% consistently self-adjusted the dose or frequency for their pigs instead of complying with prescriptions. Additionally, 3.0% consistently used antimicrobials for indications not specified in the prescriptions. Structural equation modeling yielded acceptable fit and indicated statistically significant paths from 'Relationship with the veterinarian' to 'Knowledge' (coefficient = 0.309, P<0.001) and 'Relationship with the veterinarian' to 'Practice' (0.425, P<0.001). This study revealed that not all pig farmers complied with all veterinary instructions. Strengthening the relationship between veterinarians and farmers is considered an effective strategy to improve prescription compliance.