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

Year 2025, Volume: 44 Issue: 2, 146 - 151, 31.12.2025
https://doi.org/10.30782/jrvm.1817309

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.

References

  • Adebowale OO, Jimoh AB, Adebayo OO, Alamu AA, Adeleye AI, et al. Evaluation of antimicrobial usage in companion animals at a Veterinary Teaching Hospital in Nigeria. Sci Rep. 2023;13(1):18195. https://doi.org/10.1038/s41598-023-44485-w
  • Prescott JF. Antimicrobial use in food and companion animals. Anim Health Res Rev. 2008;9(2):127-133. https://doi.org/10.1017/S1466252308001473
  • Buckland EL, O'Neill D, Summers J, Mateus A, Church D, et al. Characterisation of antimicrobial usage in cats and dogs attending UK primary care companion animal veterinary practices. Vet Rec. 2016;179(19):489. https://doi.org/10.1136/vr.103830
  • Escher M, Vanni M, Intorre L, Caprioli A, Tognetti R, et al. Use of antimicrobials in companion animal practice: a retrospective study in a veterinary teaching hospital in Italy. J Antimicrob Chemother. 2011;66(4):920-7 https://doi.org/10.1093/jac/dkq543
  • Schnepf A, Kramer S, Wagels R, Volk HA, Kreienbrock L. Evaluation of antimicrobial usage in dogs and cats at a veterinary teaching hospital in Germany in 2017 and 2018. Front Vet Sci. 2021;8: 689018 https://doi.org/10.3389/fvets.2021.689018
  • European Medicines Agency (EMA). Categorisation of antibiotics used in animals promotes responsible use to protect public and animal health. EMA/688114/2020. Media and Public Relations. 2020. https://www.ema.europa.eu/en/news/categorisation-antibiotics-used-animals-promotes-responsible-use-protect-public-animal-health Accessed January 24, 2025.
  • Cella E, Giovanetti M, Benedetti F, Scarpa F, Johnston C, et al. Joining forces against antibiotic resistance: the One Health solution. Pathogens. 2023;12(9):1074. https://doi.org/10.3390/pathogens12091074
  • Hardefeldt LY, Gilkerson JR, Billman-Jacobe H, Stevenson MA, Thursky K, et al. Barriers to and enablers of implementing antimicrobial stewardship programs in veterinary practices. J Vet Intern Med. 2018;32(3):1092-9. https://doi.org/10.1111/jvim.15083
  • EMA (European Medicines Agency) and EFSA (European Food Safety Authority), 2017. EMA and EFSA Joint Scientific Opinion on measures to reduce the need to use antimicrobial agents in animal husbandry in the European Union, and the resulting impacts on food safety (RONAFA). [EMA/CVMP/570771/2015]. EFSA Journal 2017; 15(1): 4666, 245 pp. https://doi.org/10.2903/j.efsa.2017.4666
  • Schmerold I, Van Geijlswijk I, Gehring R. European regulations on the use of antibiotics in veterinary medicine. Eur J Pharm Sci. 2023; 189: 106473. https://doi.org/10.1016/j.ejps.2023.106473
  • Allerton F, Prior C, Bagcigil AF, Broens E, Callens B, et al. Overview and evaluation of existing guidelines for rational antimicrobial use in small-animal veterinary practice in Europe. Antibiotics (Basel). 2021;10(4):409. https://doi.org/10.3390/antibiotics10040409
  • Caneschi A, Bardhi A, Barbarossa A, Zaghini A. The use of antibiotics and antimicrobial resistance in veterinary medicine, a complex phenomenon: a narrative review. Antibiotics (Basel). 2023;12(3):487. https://doi.org/10.3390/antibiotics12030487
  • Hopman NEM, Hulscher MEJL, Graveland H, Speksnijder DC, Wagenaar JA, et al. Factors influencing antimicrobial prescribing by Dutch companion animal veterinarians: a qualitative study. Prev Vet Med. 2018;158:106-13. https://doi.org/10.1016/j.prevetmed.2018.07.013
  • Bhat AH. Bacterial zoonoses transmitted by household pets and as reservoirs of antimicrobial resistant bacteria. Microb Pathog. 2021;155:104891. https://doi.org/10.1016/j.micpath.2021.104891.
  • Guardabassi L, Schwarz S, Lloyd DH. Pet animals as reservoirs of antimicrobial-resistant bacteria: Review. J Antimicrob Chemother. 2004;54(2):321-32. https://doi.org/10.1093/jac/dkh332
  • Lloyd DH, Page SW. Antimicrobial stewardship in veterinary medicine. Microbiol Spect. 2018; 6(3):10.1128/microbiolspec.arba-0023-2017. https://doi.org/10.1128/microbiolspec.ARBA-0023-2017
  • Guardabassi L, Prescott JF. Antimicrobial stewardship in small animal veterinary practice: from theory to practice. Vet Clin North Am Small Anim Pract. 2015;45(2):361-vii. http://dx.doi.org/10.1016/j.cvsm.2014.11.005
  • Prescott JF. Veterinary antimicrobial stewardship in North America. Aust Vet J. 2019; 97(7):243–248. https://doi.org/10.1111/avj.12811
  • Alhassan MY, Kabara MK, Ahmad AA, et al. Revisiting antibiotic stewardship: Veterinary contributions to combating antimicrobial resistance globally. Bull Natl Res Cent. 2025; 49: 25. https://doi.org/10.1186/s42269-025-01317-3
  • Espinosa-Gongora C, Jessen LR, Dyar OJ, et al. Towards a Better and Harmonized Education in Antimicrobial Stewardship in European Veterinary Curricula. Antibiotics (Basel). 2021;10(4):364. https://doi.org/10.3390/antibiotics10040364
  • Feyes EE, Diaz-Campos D, Mollenkopf DF, Horne RL, Soltys RC, et al. Implementation of an antimicrobial stewardship program in a veterinary medical teaching institution. J Am Vet Med Assoc. 2021;258(2):170-8. https://doi.org/10.2460/javma.258.2.170
  • Block G. Evidence-based veterinary medicine-potential, practice, and pitfalls. J Vet Intern Med. 2024;38(6):3261-3271. https://doi.org/10.1111/jvim.17239
  • Golding SE, Ogden J, Higgins HM. Shared Goals, Different Barriers: A Qualitative Study of UK Veterinarians' and Farmers' Beliefs About Antimicrobial Resistance and Stewardship. Front Vet Sci. 2019;6:132. https://doi.org/10.3389/fvets.2019.00132
  • Doron S, Davidson LE. Antimicrobial stewardship. Mayo Clin Proc. 2011;86(11):1113-1123. https://doi.org/10.4065/mcp.2011.0358

Year 2025, Volume: 44 Issue: 2, 146 - 151, 31.12.2025
https://doi.org/10.30782/jrvm.1817309

Abstract

References

  • Adebowale OO, Jimoh AB, Adebayo OO, Alamu AA, Adeleye AI, et al. Evaluation of antimicrobial usage in companion animals at a Veterinary Teaching Hospital in Nigeria. Sci Rep. 2023;13(1):18195. https://doi.org/10.1038/s41598-023-44485-w
  • Prescott JF. Antimicrobial use in food and companion animals. Anim Health Res Rev. 2008;9(2):127-133. https://doi.org/10.1017/S1466252308001473
  • Buckland EL, O'Neill D, Summers J, Mateus A, Church D, et al. Characterisation of antimicrobial usage in cats and dogs attending UK primary care companion animal veterinary practices. Vet Rec. 2016;179(19):489. https://doi.org/10.1136/vr.103830
  • Escher M, Vanni M, Intorre L, Caprioli A, Tognetti R, et al. Use of antimicrobials in companion animal practice: a retrospective study in a veterinary teaching hospital in Italy. J Antimicrob Chemother. 2011;66(4):920-7 https://doi.org/10.1093/jac/dkq543
  • Schnepf A, Kramer S, Wagels R, Volk HA, Kreienbrock L. Evaluation of antimicrobial usage in dogs and cats at a veterinary teaching hospital in Germany in 2017 and 2018. Front Vet Sci. 2021;8: 689018 https://doi.org/10.3389/fvets.2021.689018
  • European Medicines Agency (EMA). Categorisation of antibiotics used in animals promotes responsible use to protect public and animal health. EMA/688114/2020. Media and Public Relations. 2020. https://www.ema.europa.eu/en/news/categorisation-antibiotics-used-animals-promotes-responsible-use-protect-public-animal-health Accessed January 24, 2025.
  • Cella E, Giovanetti M, Benedetti F, Scarpa F, Johnston C, et al. Joining forces against antibiotic resistance: the One Health solution. Pathogens. 2023;12(9):1074. https://doi.org/10.3390/pathogens12091074
  • Hardefeldt LY, Gilkerson JR, Billman-Jacobe H, Stevenson MA, Thursky K, et al. Barriers to and enablers of implementing antimicrobial stewardship programs in veterinary practices. J Vet Intern Med. 2018;32(3):1092-9. https://doi.org/10.1111/jvim.15083
  • EMA (European Medicines Agency) and EFSA (European Food Safety Authority), 2017. EMA and EFSA Joint Scientific Opinion on measures to reduce the need to use antimicrobial agents in animal husbandry in the European Union, and the resulting impacts on food safety (RONAFA). [EMA/CVMP/570771/2015]. EFSA Journal 2017; 15(1): 4666, 245 pp. https://doi.org/10.2903/j.efsa.2017.4666
  • Schmerold I, Van Geijlswijk I, Gehring R. European regulations on the use of antibiotics in veterinary medicine. Eur J Pharm Sci. 2023; 189: 106473. https://doi.org/10.1016/j.ejps.2023.106473
  • Allerton F, Prior C, Bagcigil AF, Broens E, Callens B, et al. Overview and evaluation of existing guidelines for rational antimicrobial use in small-animal veterinary practice in Europe. Antibiotics (Basel). 2021;10(4):409. https://doi.org/10.3390/antibiotics10040409
  • Caneschi A, Bardhi A, Barbarossa A, Zaghini A. The use of antibiotics and antimicrobial resistance in veterinary medicine, a complex phenomenon: a narrative review. Antibiotics (Basel). 2023;12(3):487. https://doi.org/10.3390/antibiotics12030487
  • Hopman NEM, Hulscher MEJL, Graveland H, Speksnijder DC, Wagenaar JA, et al. Factors influencing antimicrobial prescribing by Dutch companion animal veterinarians: a qualitative study. Prev Vet Med. 2018;158:106-13. https://doi.org/10.1016/j.prevetmed.2018.07.013
  • Bhat AH. Bacterial zoonoses transmitted by household pets and as reservoirs of antimicrobial resistant bacteria. Microb Pathog. 2021;155:104891. https://doi.org/10.1016/j.micpath.2021.104891.
  • Guardabassi L, Schwarz S, Lloyd DH. Pet animals as reservoirs of antimicrobial-resistant bacteria: Review. J Antimicrob Chemother. 2004;54(2):321-32. https://doi.org/10.1093/jac/dkh332
  • Lloyd DH, Page SW. Antimicrobial stewardship in veterinary medicine. Microbiol Spect. 2018; 6(3):10.1128/microbiolspec.arba-0023-2017. https://doi.org/10.1128/microbiolspec.ARBA-0023-2017
  • Guardabassi L, Prescott JF. Antimicrobial stewardship in small animal veterinary practice: from theory to practice. Vet Clin North Am Small Anim Pract. 2015;45(2):361-vii. http://dx.doi.org/10.1016/j.cvsm.2014.11.005
  • Prescott JF. Veterinary antimicrobial stewardship in North America. Aust Vet J. 2019; 97(7):243–248. https://doi.org/10.1111/avj.12811
  • Alhassan MY, Kabara MK, Ahmad AA, et al. Revisiting antibiotic stewardship: Veterinary contributions to combating antimicrobial resistance globally. Bull Natl Res Cent. 2025; 49: 25. https://doi.org/10.1186/s42269-025-01317-3
  • Espinosa-Gongora C, Jessen LR, Dyar OJ, et al. Towards a Better and Harmonized Education in Antimicrobial Stewardship in European Veterinary Curricula. Antibiotics (Basel). 2021;10(4):364. https://doi.org/10.3390/antibiotics10040364
  • Feyes EE, Diaz-Campos D, Mollenkopf DF, Horne RL, Soltys RC, et al. Implementation of an antimicrobial stewardship program in a veterinary medical teaching institution. J Am Vet Med Assoc. 2021;258(2):170-8. https://doi.org/10.2460/javma.258.2.170
  • Block G. Evidence-based veterinary medicine-potential, practice, and pitfalls. J Vet Intern Med. 2024;38(6):3261-3271. https://doi.org/10.1111/jvim.17239
  • Golding SE, Ogden J, Higgins HM. Shared Goals, Different Barriers: A Qualitative Study of UK Veterinarians' and Farmers' Beliefs About Antimicrobial Resistance and Stewardship. Front Vet Sci. 2019;6:132. https://doi.org/10.3389/fvets.2019.00132
  • Doron S, Davidson LE. Antimicrobial stewardship. Mayo Clin Proc. 2011;86(11):1113-1123. https://doi.org/10.4065/mcp.2011.0358
There are 24 citations in total.

Details

Primary Language English
Subjects Veterinary Surgery
Journal Section Research Article
Authors

Nurçin Yılmaz 0009-0001-1946-3502

Havvagül Sert 0009-0005-2818-3659

Murat Cengiz 0000-0001-7601-7640

Submission Date November 4, 2025
Acceptance Date December 7, 2025
Publication Date December 31, 2025
Published in Issue Year 2025 Volume: 44 Issue: 2

Cite

APA Yılmaz, N., Sert, H., & Cengiz, M. (2025). Systemic Barriers to Antimicrobial Stewardship in Turkiye: Insights from Veterinary Practices. Journal of Research in Veterinary Medicine, 44(2), 146-151. https://doi.org/10.30782/jrvm.1817309
AMA Yılmaz N, Sert H, Cengiz M. Systemic Barriers to Antimicrobial Stewardship in Turkiye: Insights from Veterinary Practices. J Res Vet Med. December 2025;44(2):146-151. doi:10.30782/jrvm.1817309
Chicago Yılmaz, Nurçin, Havvagül Sert, and Murat Cengiz. “Systemic Barriers to Antimicrobial Stewardship in Turkiye: Insights from Veterinary Practices”. Journal of Research in Veterinary Medicine 44, no. 2 (December 2025): 146-51. https://doi.org/10.30782/jrvm.1817309.
EndNote Yılmaz N, Sert H, Cengiz M (December 1, 2025) Systemic Barriers to Antimicrobial Stewardship in Turkiye: Insights from Veterinary Practices. Journal of Research in Veterinary Medicine 44 2 146–151.
IEEE N. Yılmaz, H. Sert, and M. Cengiz, “Systemic Barriers to Antimicrobial Stewardship in Turkiye: Insights from Veterinary Practices”, J Res Vet Med, vol. 44, no. 2, pp. 146–151, 2025, doi: 10.30782/jrvm.1817309.
ISNAD Yılmaz, Nurçin et al. “Systemic Barriers to Antimicrobial Stewardship in Turkiye: Insights from Veterinary Practices”. Journal of Research in Veterinary Medicine 44/2 (December2025), 146-151. https://doi.org/10.30782/jrvm.1817309.
JAMA Yılmaz N, Sert H, Cengiz M. Systemic Barriers to Antimicrobial Stewardship in Turkiye: Insights from Veterinary Practices. J Res Vet Med. 2025;44:146–151.
MLA Yılmaz, Nurçin et al. “Systemic Barriers to Antimicrobial Stewardship in Turkiye: Insights from Veterinary Practices”. Journal of Research in Veterinary Medicine, vol. 44, no. 2, 2025, pp. 146-51, doi:10.30782/jrvm.1817309.
Vancouver Yılmaz N, Sert H, Cengiz M. Systemic Barriers to Antimicrobial Stewardship in Turkiye: Insights from Veterinary Practices. J Res Vet Med. 2025;44(2):146-51.