Understanding how veterinarians’ knowledge, attitudes, and practices influence antibiotic prescription: a systematic review of survey studies

This systematic review analyzed 59 studies (2004–2023) on how non-clinical factors influence veterinarians’ antibiotic prescribing practices across livestock, small animal, equine, and mixed veterinary settings. It found that veterinarians’ decisions are shaped not only by medical needs but also by multiple intrinsic factors—such as self-confidence, fear of poor outcomes, desire to meet client expectations, and limited knowledge—and extrinsic factors like client pressure, poor farm hygiene, time and cost constraints, lack of diagnostic support, and inadequate policies or guidelines. High client demand and deficient awareness about AMR among animal owners were strongly linked to higher antibiotic use. The review concludes that many of these factors are modifiable, highlighting the need for One Health–based interventions, education, and better stewardship policies to promote responsible antibiotic use in veterinary practice.