Systemic Barriers to Antimicrobial Stewardship in Turkiye: Insights from Veterinary Practices

Abstract

Antimicrobial resistance (AMR) is a critical global health threat, significantly impacting both human and veterinary medicine. In Türkiye, systemic barriers hinder the effective implementation of antimicrobial stewardship (AMS) in veterinary practice, exacerbating the risks associated with inappropriate antimicrobial use. This study investigates the challenges limiting AMS adoption by analysing veterinarians' prescribing behaviours, diagnostic practices, and adherence to evidence-based guidelines. A cross-sectional survey of 163 veterinarians in Istanbul and Bursa revealed a predominant reliance on empirical antimicrobial prescribing, with third-generation cephalosporins and fluoroquinolones among the most frequently used drug classes. Despite widespread awareness of AMR (92.8%), only 11% of veterinarians reported receiving structured AMS training, and 24% did not utilize microbiological diagnostics for guiding therapy, often citing economic constraints and logistical barriers. Additionally, AMS strategies were predominantly reactive, with 64% of respondents favouring retrospective case review over proactive prescribing restrictions. Key barriers to AMS implementation included financial pressures, regulatory gaps, limited diagnostic accessibility, and client-driven demands for antimicrobial therapy. These findings underscore the urgent need for targeted AMS education, improved diagnostic infrastructure, and robust regulatory frameworks to optimize antimicrobial use and curb resistance within Türkiye’s veterinary sector. A multidisciplinary One Health approach is essential to align veterinary practices with global AMR mitigation strategies and ensure sustainable antimicrobial efficacy.

Keywords

• antimicrobial resistance
• antimicrobial stewardship
• veterinary medicine
• one health

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