After decades in small animal medicine, I've decided to "retire" by taking a right-hand turn into ruminant medicine. Since embarking on this journey of goat and cattle discovery and starting my own commercial goat dairy and beef cattle operation, I've had to re-learn the differences between small animal practice and food animal medicine run considerably deeper—most notably on the regulatory side of things.

 

Take antimicrobials, for example

While reacquainting myself with food animal medicine, I've been struck by just how thoroughly the subject of antimicrobial stewardship permeates the discipline. Whether the topic is infectious disease, routine surgery, or something as mundane as treating a wound or castrating a kid, the conversation invariably turns to drug selection, legal restrictions, withdrawal times, and the implications of treatment for the food supply.

It's not a separate lecture on antimicrobial stewardship. It's baked into practically everything. You can't attend a CE session or keep records without hearing the acronyms AMDUCA or FARAD either out loud or in your head.

 

The antimicrobial divide

Meanwhile, I still practice small animal medicine (for both fun and profit), where antibiotics remain something we prescribe with shocking abandon. Diarrhea? Metronidazole. A clean surgical incision? Better send home some cephalexin. A cat with urinary signs? Perhaps a little Convenia, just in case. Kennel cough? You guessed it.

Never mind our evidence doesn't support any of these meds in the uncomplicated cases we routinely encounter.

The contrast has been something of a professional wake-up call. After decades in small animal practice, I've become so accustomed to our prescribing culture I'd almost forgotten how differently another branch of our own profession approaches the same drugs.

Which raises an uncomfortable question: How did we arrive at a place where the veterinarians treating animals destined for our dinner tables are held to one standard of antibiotic accountability, while those of us treating animals that sleep in our beds operate under another?

It's not that we don't know what we should be doing (or not doing). It's that the small animal industry hasn't been forced to confront what it means in the same way our food animal counterparts have.

Some food animal history

How did food animals vets get to a place where antimicrobials stewardship became such a priority? For those of you who didn't get a chance to live through the '90s (while in practice, anyway), here's a brief rundown on how we achieved regulations that made veterinarians and producers accountable for how drugs are used.

• In 1994, Congress passed AMDUCA (the Animal Medicinal Use Clarification Act), legalizing certain extra-label drug uses while imposing safeguards for food animals. Veterinarians gained prescribing flexibility but assumed responsibility for preventing illegal residues through appropriate withdrawal intervals and treatment records.
• By 1997, there were additional restrictions. The FDA prohibited extra-label use of fluoroquinolones in food animals, recognizing the threat resistant bacteria posed to human health.
• In 2017, the rules tightened even more. Medically important antibiotics (important to humans, that is) could no longer be used for growth promotion. Their administration in feed or water required intensive veterinary oversight, with medicated feeds subject to the Veterinary Feed Directive.
• In 2023, another loophole closed. Most over-the-counter medically important antibiotics (again, to humans), including many injectables, became prescription-only.

The practical consequences? More veterinary involvement, more paperwork, fewer unrestricted drug choices, and serious economic penalties when treated animals' milk had to be discarded or when slaughter had to be delayed or carcasses condemned. In other words, antibiotic stewardship became part of the business of raising livestock. Which means it also became a major source of liability for food animal veterinarians.

These changes have made an enormous impact on the culture of an entire generation of food animal practitioners.

 

Meanwhile, back at the clinic

The difference is jarring, really. In small animal hospital settings we're likely to prescribe antibiotics multiple times a day. We often do it reflexively. In fact, client cost concerns and expectations are probably more of a factor in our antibiotic selection decisions than antimicrobial resistance!

The most interesting part is we small animal practitioners know we over-prescribe. Just ask anyone you know and, if they're honest, they're sure to confess to at least once in the past week (or daily!) having prescribed antibiotics because of…

1. Direct or indirect client pressure
2. Fear of treatment failure or poor outcome
3. The antibiotics' perceived anti-inflammatory or immunomodulating effect
4. A therapeutic reflex ("I've always prescribed X antimicrobial because it works")

Meanwhile, most of us know it's probably not the best way to practice. A recent study on metronidazole use in small animal medicine¹ backs me up on this. It finds that the awareness of stewardship guidelines doesn't equate to lower metronidazole prescribing frequency. While newer grads and academic vets were more likely to follow guidelines, the authors concluded that attitudes toward clinical risk and perceived social pressure were more influential than guideline knowledge alone. Bottom line: We prescribe it even when we damn well know we shouldn't.

That's kind of scary, but it tracks. It's human nature, after all, to conform to the standards and expectations of the practices we work at along with our clients' assumptions that antibiotics provide a universal solution.

Be honest: When was the last time you consulted the antimicrobial use guidelines? Do you know the recommended length of time evidence shows you're really supposed to prescribe a specific antibiotic for a UTI? Do you culture ears and skin? Do you bother to properly interpret MICs on your sensitivity results or do you select the most expedient antibiotic?

 

More truths behind over-prescribing

Truth is, no one's holding our feet to the fire if our patients get antibiotics they don't require. No one's checking our records or looking over our shoulders. In fact, if anything, we're incentivized to over-prescribe, and not just because we don't want cranky owners, to engage in long-winded explanations, or handle incomplete or poor outcomes where our appropriate reluctance to over-prescribe means rechecks and even crankier clients. (Which literally just happened to me 15 minutes ago on a culture-pending UTI case.)

In fact, we also over-prescribe because we're economically incentivized to do so. If we want to make production, most of us are acutely aware that an extra $50 to $200 on the bill means an additional 18-22 percent of income. It adds up. Moreover, most of our practice owners tacitly encourage over-prescription, too.

At some level, we understand our bed-sharing patients are undoubtedly contributing both directly and indirectly to antibiotic resistance when we over-prescribe. If we're earnestly on board with our One Health principles and we keep up with the literature that should guide our decisions, we should know we're part of the problem.

We're not bad veterinarians

The point isn't small animal veterinarians are bad while livestock veterinarians are inherently more conscientious about antimicrobial resistance. It's that their prescribing decisions are shaped by an external system that threatens serious consequences if they misuse these drugs.

So the question becomes: Why hasn't companion animal medicine developed comparably consequential accountability for inappropriate prescribing?

It's not ethical (or legal, really) to over-prescribe. Yet we face no consequences when we do. So, what reasonable backstops should be imposed to restrict our misuse? Should our records be interrogated and antibiotic use controlled along with all our scheduled drugs? Would you oppose these regulations like many food animal vets once did? Our corporate owners certainly would!

Sure, it would add an expensive and stressful feature to our practicing lives. However, livestock vets adjusted, and we would too. Why? Because One Health shouldn't be a buzzword we blithely invoke. It should be a mantra we earnestly adopt, with real-world consequences should we not.

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

 

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