The VALUE of antibiotic stewardship for companion animals: Understanding appropriate antibiotic prescribing for pet cats and dogs in veterinary clinics in Singapore.

Understanding the factors influencing antibiotic prescribing for pets can inform future interventions to prevent development and spillover of antimicrobial resistance (AMR) from pets to other animals, humans and the wider environment. We conducted interviews with 19 veterinarians (January-July 2022) to explore factors influencing antibiotic prescribing for cats and dogs. Thematic analysis was performed using a VALUE model and themes were segmented by consultation touchpoints. We observed that veterinary clinics in Singapore heavily prioritised business viability. Existing antibiotic stewardship efforts driven by individual veterinarians were often justified as meeting pet owners' satisfaction instead. National guidelines being loosely followed, but AMR-related values and practices were mostly aligned to those of key decision-making veterinarians. Open discussions on antibiotic prescribing amongst different veterinary professionals and shared decision-making (SDM) with pet owners were common. Audits were welcomed by veterinarians but resource limitations were a major concern. Recommendations to support veterinarians in prescribing antibiotics appropriately for cats and dogs range from formalising antibiotic stewardship as a clinic value, providing collective training for all veterinary professionals, continuing SDM with pet owners, automating tracking of meaningful indicators for monitoring and evaluation, and setting up a feedback system to inform behaviour change.