Why Companion Animal Antibiotic Prescribing Needs Stronger Accountability

Antibiotic stewardship has a built-in accountability system in food animal medicine. In companion animal practice, veterinarians can know the guidelines and still prescribe antibiotics out of habit, client pressure or fear of a poor outcome. That difference points to a professional challenge: knowledge alone hasn’t changed prescribing culture, and the consequences for unnecessary use remain limited.

That’s the contrast Patty Khuly, VMD, MBA, says she encountered after decades in small animal medicine and a move into goat and cattle farming. She continues to practice small animal medicine while operating a commercial goat dairy and beef cattle business. In her view, changing fields made one distinction hard to miss: decisions about antimicrobials are woven into routine food animal care, while companion animal clinics can treat them as an ordinary part of the prescription pad.

Food animal practice builds stewardship into routine care

In food animal medicine, antibiotic questions surface across a wide range of work, from infectious disease and surgery to wounds and castration. Drug selection, legal limits, withdrawal intervals and the consequences for the food supply are part of those decisions. Khuly describes antimicrobial stewardship as a constant consideration, reinforced in continuing education and recordkeeping through references to AMDUCA and FARAD.

The framework developed over several decades. Congress passed the Animal Medicinal Drug Use Clarification Act, or AMDUCA, in 1994. It allowed certain extra-label uses of approved drugs while requiring safeguards for food animals. Veterinarians gained flexibility but also responsibility for setting appropriate withdrawal intervals and maintaining treatment records to prevent illegal residues.

Restrictions expanded in 1997, when the FDA prohibited extra-label use of fluoroquinolones in food animals, citing concern about resistant bacteria and human health. In 2017, medically important antibiotics could no longer be used for growth promotion. Their use in feed or water required veterinary oversight, and medicated feed became subject to the Veterinary Feed Directive. In 2023, most over-the-counter medically important antibiotics, including many injectables, became prescription-only.

For producers and veterinarians, those rules have practical costs: more veterinary involvement and paperwork, fewer drugs available for unrestricted use, and financial consequences when milk must be discarded or slaughter delayed. The measures also made antimicrobial use a routine business concern and a source of liability for food animal veterinarians. Khuly argues that this system helped shape a generation of practitioners accustomed to weighing stewardship alongside treatment.

Companion animal prescribing follows different pressures

Khuly describes a sharply different pattern in small animal clinics, where antibiotics may be prescribed for uncomplicated diarrhea, clean surgical incisions, urinary signs or kennel cough despite a lack of evidence supporting their routine use in those cases. The examples point to a familiar clinical reflex: when an antibiotic is available, prescribing it can feel like a practical way to respond to uncertainty or satisfy expectations.

Several pressures can push clinicians in that direction. Clients may ask for medication, or veterinarians may worry that withholding it will lead to treatment failure, a poor outcome or a difficult conversation. Some prescriptions are based on a perceived anti-inflammatory or immunomodulating effect; others persist because a drug has long been part of a clinician’s routine. Those motives can crowd out guideline recommendations even when practitioners understand them.

A 2026 study cited by Khuly examined metronidazole use for canine acute diarrhea. Its authors found that awareness of stewardship guidelines did not, by itself, translate into lower prescribing frequency. New graduates and academic veterinarians were more likely to follow the guidance, but clinicians’ attitudes toward risk and perceived social pressure had a stronger influence than guideline knowledge alone.

That finding helps explain why reminders and education may not be enough. Prescribing happens within a workplace culture shaped by colleagues, owners’ expectations and the desire to avoid a disappointing outcome. A veterinarian who declines antibiotics may need to explain the choice, arrange follow-up and manage the possibility that a patient’s condition will worsen. Even when withholding an unnecessary drug is medically sound, the short-term path can feel harder.

Financial incentives complicate the decision

Khuly also points to business pressures. In some practices, adding a medication can increase the bill by $50 to $200. She estimates that this can contribute an additional 18 to 22 percent of income toward production targets. Owners may also tacitly support prescribing patterns that raise revenue.

Those incentives sit alongside client pressure and clinical uncertainty. Together, they can reward a prescription in the moment, while the wider cost of antimicrobial resistance is harder to see in an individual appointment. Khuly says companion animal veterinarians should recognize that unnecessary antibiotic use can contribute to resistance, including through effects that reach beyond a single patient. That concern connects prescribing decisions to the profession’s One Health commitments.

Accountability could change the culture

Khuly’s argument isn’t that small animal veterinarians are less conscientious than their food animal colleagues. The professions operate under different systems. Food animal veterinarians face defined restrictions, documentation requirements and real financial consequences when drugs are misused. Companion animal clinicians, she says, face few comparable checks on whether antibiotics were needed.

That raises a question about what meaningful accountability could look like in companion animal practice. Khuly asks whether antibiotic records should receive closer review and whether use should be controlled in ways similar to scheduled drugs. Such oversight would add cost and stress for clinicians, and practice owners might resist it. Food animal veterinarians, too, once objected to tighter requirements, but adapted as the rules became part of daily work.

Rules alone can’t resolve every clinical judgment or remove the pressures of a busy clinic. But the comparison suggests that prescribing habits respond to the systems around them. If companion animal medicine expects clinicians to follow stewardship guidance, it may need workplace practices and oversight that make careful prescribing easier to sustain than reflexive treatment. For Khuly, One Health has meaning only when it shapes real decisions, including the routine choice to leave an antibiotic off the bill.

After selling her small animal practice in Miami, Patty Khuly, VMD, MBA, works as an associate small animal practitioner in Miami, Florida, and as a relief veterinarian in Charlottesville, Virginia. She also owns and operates Crossroads Farm, a goat dairy and cattle operation in North Garden, Virginia.

Reference

1. Frey E, Hatcher CC, Snavely NR, et al. New graduates and academic veterinarians' intentions to treat canine acute diarrhea align with antimicrobial stewardship guidelines. J Am Vet Med Assoc. 2026;264(5):1-9. doi:10.2460/javma.25.10.0594