Knowledge, attitudes and practices towards antibiotic prescription by veterinarians: A systematic review of qualitative studies.

Abstract

Antimicrobial resistance (AMR) is a public health problem with global impacts. Thus, responsible antibiotic use across human and veterinary health sectors must be fostered. Veterinarians play a crucial role in antimicrobial stewardship (AMS), yet their prescribing attitudes are influenced by a complex interplay of factors. This study aimed to collect and synthesize evidence from qualitative studies focusing on the knowledge, attitudes, and practices of veterinarians regarding antibiotic prescription to identify the factors influencing clinical decisions and contribute to AMS strategies. This systematic review followed PRISMA and ENTREQ guidelines, with a protocol registered in PROSPERO (CRD42024529868). On 15 March 2024, the databases Medline/PubMed, EMBASE, Web of Knowledge, and CAB International were searched without time restrictions, and an updated search was conducted on September 11, 2025. Only qualitative and mixed methods studies involving veterinarians working with companion or food-producing animals were included. Critical appraisal was performed using the Joanna Briggs Institute checklist for qualitative research. After search and screening, 28 studies were included, with data mostly being collected through interviews. In total, 34 influencing factors were identified: intrinsic (n = 12) and extrinsic factors (n = 22). Among the intrinsic factors, professional experience, the need to satisfy client's expectations, fear of clinical complications, and fear of losing clients were the most identified. Among the extrinsic factors, client-related (financial resources, expectations, and compliance), antibiotic characteristics, disease prevention, and animal clinical status were identified as main drivers for antibiotic selection and prescribing. Larger-scale mixed methods or longitudinal studies, especially in underrepresented regions, should be encouraged. Strategies under the One Health approach should be effectively implemented to promote the rational use of antibiotics in veterinary medicine, integrating continuing education, easily accessible, practical, and updated regulatory policies and guidelines, animal facilities improvement, and programs that strengthen communication between veterinarians and animal owners.