Gastrointestinal (GI) disease is common in small animal practice, and cats and dogs presenting with GI signs are often treated symptomatically with antimicrobials without undergoing specific diagnostic testing. Although support and guidance is available to avoid the development of antimicrobial resistance through responsible veterinary antimicrobial use, especially regarding highest priority critically important antimicrobials (HPCIA), further strategies based on a greater understanding of antimicrobial prescription at the population-level are needed.

This mixed-methods observational study aimed to characterise the use of antimicrobials in canine and feline GI presentations, and to explore the justification and reasoning behind their prescription.

A total of 23,337 electronic health records from the small animal veterinary surveillance network (SAVSNET) database and structured questionnaire responses from veterinary surgeons regarding 225 canine and feline GI consultations in the UK between 2014 and 2018 were analysed.

Most consultations were first visits; the majority (83.4%) were reported as mild GI presentations, with non-haemorrhagic diarrhoea and vomiting as the most common signs. Systemic antimicrobials were administered in 28.6% of canine and 22.4% of feline cases, despite guidelines stating that acute GI presentations, including dogs with haemorrhagic diarrhoea, in cats and dogs that are systemically well do not require any antimicrobial therapy.1

The most commonly prescribed systemically administered antimicrobial in feline consultations was clavulanic acid potentiated amoxicillin, which the European Medicines Agency advises should be used with caution.2 In dogs, metronidazole was the most commonly prescribed systemically administered antimicrobial, which is recommended only for chronic diarrhoea/enteropathy treatment after all other diagnostic options and empirical therapy possibilities have been exhausted.1,3 Together, this suggests limited compliance with published guidelines.

Ten major themes were identified from clinical narratives about the reasoning behind HPCIA prescription, including perceived compliance, owner behaviour (pressure and expectations), and perceived risk of infection. No explicit justification for HPCIA prescription was recorded in 77% of cases. The findings of this study will help inform targeted interventions, contributing towards enhanced antimicrobial stewardship.

The paper, published in the December 2023 issue of Frontiers in Veterinary Science, can be accessed here.

  1. Antibiotic Guardian. BSAVA/SAMSoc guide to responsible use of Antibacterials: PROTECT ME. Quedgeley: British Small Animal Veterinary Association (2018).
  2. Antimicrobial Advice Ad Hoc Expert Group E. Categorisation of antibiotics for use in animals for prudent and responsible use. Amsterdam. (2020). Available at:
  3. Singleton DA, Noble PJM, Sánchez-Vizcaíno F, Dawson S, Pinchbeck GL, Williams NJ, et al. Pharmaceutical prescription in canine acute Diarrhoea: a longitudinal electronic health record analysis of first opinion veterinary practices. Front Vet Sci. (2019) 6:218. doi: 10.3389/fvets.2019.00218