Interventions to Reduce Antibiotic Prescribing in Small Animal Veterinary Practice: Evidence and Clinical Impact.

Antimicrobial resistance represents a major One Health challenge affecting human, animal, and environmental health, and responsible antimicrobial use in companion animal medicine has become increasingly important. This narrative review synthesizes current evidence on antimicrobial stewardship interventions aimed at improving antibiotic prescribing in small animal veterinary practice. The review discusses the clinical, behavioral, owner-related, organizational, and regulatory factors that influence prescribing decisions, with emphasis on diagnostic uncertainty, access to microbiological testing, communication with pet owners, and practice-level prescribing culture. Key stewardship strategies include evidence-based clinical guidelines, diagnostic stewardship, education and training, audit and feedback, electronic clinical decision-support systems, antimicrobial resistance surveillance, infection prevention, and multifaceted implementation programs. Evidence from predominantly observational and before-and-after studies suggests that these interventions may be associated with reductions in unnecessary antimicrobial prescribing and improvements in prescribing appropriateness, although the strength of causal evidence remains limited. However, further research is needed because current studies differ in methodology, often have short follow-up periods, include limited data from routine primary veterinary practices, and rarely demonstrate a direct reduction in antimicrobial resistance. Future progress will depend on standardized outcome measures, integration of digital health technologies, rapid diagnostics, artificial intelligence, antimicrobial resistance surveillance, and stronger One Health collaboration. Overall, antimicrobial stewardship in companion animal medicine should be regarded as a continuous quality-improvement process designed to preserve antimicrobial efficacy while maintaining optimal patient care.