Quality Of Antibiotic Prescribing Research Articles

Treatment and Management of Bacterial Purulent Acute Otitis at the Bogodogo District Community Hospital, Burkina Faso, West Africa

Background: This is a descriptive short report of a cross-sectional study conducted in the Otorhinolaryngology unit (ORL) of the Bogodogo district community hospital and in the Unit of Bacteriology/Virology of the National Laboratory of Public Health. This study sought to provide insight into the quality of antibiotic prescribing in patients with purulent acute otitis media (PAOM) to establish a better treatment and management of local population ‘health. Methods and findings: A cross-sectional investigation was carried out from June 2014 to January 2015. Here, we reported and included in the analysis 58 cases of antibiotic-naive patients diagnosed with purulent acute otitis media seen in the otorhinolaryngology unit of the Bogodogo district community hospital. Thirtyone (31) patients were over 15 years. Males were the dominant group with a sex ratio of 1.3. Sixty-two (62) bacterial strains were isolated from patient samples of which Staphylococci, Enterobacteriaceae and Pseudomonas accounted for 37.1%, 32.2% and (22.6%), respectively. Among the antibiotics tested, four (4) classes proved effective: Gentamycin (98%), Ciprofloxacin (97%), Imipenem (82%) and the 3rd generation of Ceftriaxone (76%).However, the sensitivity to Ampicillin and Amoxicillin + clavulanic acid was very low. Conclusions: Self-medicating, over-prescribing unnecessary drugs are among the cause of resistance to antibiotic treatment. We were able to identify the main bacteria involved in purulent acute otitis and hope this effort of generating data will be useful to improve the care for patient in Burkina and beyond in Sun- Saharan Africa.

An assessment of the quality of antibiotic prescription in Katutura health centre, Khomas region.

Background: Although the discovery of antibiotics revolutionized medicine and reduced mortality and morbidity rates, antibiotic resistance is a threat to these advances in medicine as infections are again rendered untreatable and causing a significant number of deaths worldwide. The Namibian Standard Treatment Guidelines which if followed, would standardize treatment of conditions in the country according to acceptable guidelines, preventing inappropriate and unnecessary prescriptions of medicines, serve as current prescription guidelines. The hypothesis of the researcher was that prescribers are frequently non-compliant to the Namibian Standard Treatment Guidelines. Methodology: Katutura Health Centre was the chosen representative facility and prescriptions were evaluated and compliance to the Namibian Standard Treatment Guidelines was assessed as well as the qualification of the prescriber, the diagnoses made and the antibiotics prescribed. Patient passports were screened at the dispensing points and details were recorded concerning antibiotic prescriptions. The data was evaluated for Namibian Standard Treatment Guidelines compliance and entered into EpiInfo version 7.1.1.14 and analysed. Results and Discussion: Prescribers were 51% compliant. Medical Officers wrote 66% of the prescriptions, Registered nurses 23% and Enrolled nurses 11%, with a compliance rate of 50%, 66% and 23% respectively. Respiratory and urogenital conditions were most prevalent and had poor compliance. Commonly prescribed antibiotics were Amoxicillin, Azithromycin and Metronidazole with respective rates of 46.25%, 23.08% and 13.29% for the three respectively. This correlates with a study done in Namibia, stating that the three most commonly indicated antibiotics in the NSTG were Cotrimoxazole, Amoxicillin and Azithromycin (CAA) at 49.3%.

Optimising the quality of antibiotic prescribing in out-of-hours primary care in Belgium: a study protocol for an action research project

IntroductionAntimicrobial resistance is a major public health threat driven by inappropriate antibiotic use, mainly in general practice and for respiratory tract infections. In Belgium, the quality of general practitioners’ (GPs)...

Assessing the quality of paediatric antibiotic prescribing by community paediatricians: a database analysis of prescribing in Lombardy

ObjectiveTo evaluate the quality of paediatricians’ antibiotic prescribing using administrative databases.MethodsThe data source was the database of reimbursed prescriptions of the Lombardy Region, Italy. Children 1–13 years were included. An...

Quality of antibiotic prescribing of Swiss primary care physicians with high prescription rates: a nationwide survey.

To assess the quality of antibiotic prescribing of Swiss primary care physicians with high prescription rates. In January 2015, we mailed a structured questionnaire to 2900 primary care physicians in Switzerland. They were included in a nationwide pragmatic randomized controlled trial on routine antibiotic prescription monitoring and feedback based on health insurance claims data. We asked them to record the diagnosis and antibiotic treatment for 44 consecutive patients with the most common conditions associated with antibiotic prescribing in primary care. We evaluated if the disease-specific antibiotic prescribing and the proportion of non-recommended antibiotics used, in particular quinolones, were within 'acceptable ranges' using adapted European Surveillance of Antimicrobial Consumption (ESAC) quality indicators. Two hundred and fifty physicians (8.6%) responded, providing 9961 patient records. Responders were similar to the entire physician population. Overall, antibiotics were prescribed to 32.1% of patients. For tonsillitis/pharyngitis, acute otitis media, acute rhinosinusitis and acute bronchitis the acceptable maximum of antibiotic prescriptions was exceeded by 24.4%, 49.6%, 27.4% and 11.5%, respectively. The proportion of non-recommended antibiotics was for all diagnoses above the recommended maximum of 20% (31.5%-88.7% across all conditions). Quinolones were prescribed to 37.2% of women with urinary tract infections, substantially exceeding the recommended maximum of 5%. Antibiotic prescribing quality of Swiss primary care physicians with high prescription rates is low according to the indicators used, with substantial overtreatment of tonsillitis/pharyngitis, acute rhinosinusitis, acute otitis media and acute bronchitis. Routine nationwide and continuous monitoring of antibiotic use and specific interventions are warranted to improve prescribing in primary care.

Is there any difference in quality of prescribing between antibacterials and antifungals? Results from the first global point prevalence study (Global PPS) of antimicrobial consumption and resistance from 53 countries.

To compare the quality of antibacterial with antifungal prescribing in the world. Data from the global point prevalence study (Global PPS) were used. The Global PPS took place on any one day between February and June 2015 in 335 participating hospitals from 53 countries. It collected demographic data on patients treated with antimicrobials and data on prescription characteristics of the antimicrobials. For the present study, the quality of antibiotic prescription was compared with antifungal prescription using logistic regression analysis. The following indicators were compared: the presence of the reason for prescription and stop/review date in notes, and compliance with a local guideline. There were 48565 antimicrobial prescriptions for 34731 patients [median age 63 years (range 0-106); 52.6% male] in the Global PPS. Among these antimicrobials, 43513 (89.6%) were antibacterials and 2062 were antifungals for systematic use, and these data were used in this study. Reasons for prescriptions [77.7% versus 71.8%, OR 1.4 (95% CI 1.2-1.5)] and stop/review dates [38.3% versus 31.9%, OR 1.3 (1.2-1.5)] were found more often in notes for antibacterials than for antifungals. Antibacterials were prescribed less often according to local guidelines than antifungals [57.0% versus 71.0%, OR 0.6 (0.5-0.6)]. There are differences in the quality of antibacterial and antifungal prescribing and we identified opportunities that can be used to improve the quality of antimicrobial prescribing.

Impact of an antimicrobial stewardship programme to optimize antimicrobial use for outpatients at an emergency department

Antimicrobial stewardship programmes (ASPs) have been effective in optimizing antibiotic use for inpatients. However, an emergency department's fast-paced clinical setting can be challenging for a successful ASP. In April 2015, an ASP was implemented in our emergency department and we aimed to determine its impact on antimicrobial use for outpatients. This was a single-centre study comparing the quality of antibiotic prescriptions between a one-year period before ASP implementation (November 2012 to October 2013) and a one-year period after its implementation (June 2015 to May 2016). For each period, antimicrobial prescriptions for all adult outpatients (hospitalized for <24h) were evaluated by an infectious disease specialist and an emergency department physician to assess compliance with local prescribing guidelines. Inappropriate prescriptions were then classified. Before and after ASP, 34,671 and 35,925 consultations were registered at our emergency department, of which 25,470 and 26,208 were outpatients. Antimicrobials were prescribed in 769 (3.0%) and 580 (2.2%) consultations, respectively (P<0.0001). There were 484 (62.9%) and 271 (46.7%) (P<0.0001) instances of non-compliance with guidelines before and after ASP implementation. Non-compliance included unnecessary antimicrobial prescriptions, 197 (25.6%) vs 101 (17.4%) (P<0.0005); inappropriate spectrum, 108 (14.0%) vs 54 (9.3%) (P=0.008); excessive treatment duration, 87 (11.3%) vs 53 (9.1%) (P>0.05); and inappropriate choices, 11 (1.4%) vs 15 (2.6%) (P>0.05). The implementation of an ASP markedly decreased the number of unnecessary antimicrobial prescriptions, but had little impact on most other aspects of inappropriate prescribing.

The impact of interventions to improve the quality of prescribing and use of antibiotics in primary care patients with respiratory tract infections: a systematic review protocol

IntroductionRespiratory tract infections (RTIs) are the most common reason for primary care (PC) consultations and for antibiotic prescribing and use. The majority of RTIs have a viral aetiology however, and...

Characterisation of antibiotic prescriptions for acute respiratory tract infections in Danish general practice: a retrospective registry based cohort study

Inappropriate use of antibiotics is contributing to the increasing rates of antimicrobial resistance. Several Danish guidelines on antibiotic prescribing for acute respiratory tract infections in general practice have been issued to promote rational prescribing of antibiotics, however it is unclear if these recommendations are followed. We aimed to characterise the pattern of antibiotic prescriptions for patients diagnosed with acute respiratory tract infections, by means of electronic prescriptions, labeled with clinical indications, from Danish general practice. Acute respiratory tract infections accounted for 456,532 antibiotic prescriptions issued between July 2012 and June 2013. Pneumonia was the most common indication with 178,354 prescriptions (39%), followed by acute tonsillitis (21%) and acute otitis media (19%). In total, penicillin V accounted for 58% of all prescriptions, followed by macrolides (18%) and amoxicillin (15%). The use of second-line agents increased with age for all indications, and comprised more than 40% of the prescriptions in patients aged >75 years. Women were more often prescribed antibiotics regardless of clinical indication. This is the first Danish study to characterise antibiotic prescription patterns for acute respiratory tract infections by data linkage of clinical indications. The findings confirm that penicillin V is the most commonly prescribed antibiotic agent for treatment of patients with an acute respiratory tract infection in Danish general practice. However, second-line agents like macrolides and amoxicillin with or without clavulanic acid are overused. Strategies to improve the quality of antibiotic prescribing especially for pneumonia, acute otitis media and acute rhinosinusitis are warranted.

Quality Assesment of Antibiotic Prescription for Sepsis Treatment in Intensive Care Unit at Top Referral Hospital in West Java, Indonesia

Background: Sepsis is a common disease in intensive care unit (ICU) with high mortality rate. Administration of antibiotic has an important role to determine the outcome of sepsis patient. This study aimed to evaluate the quality of antibiotic prescription for sepsis treatment in intensive care unit (ICU). Methods: This descriptive study was conducted by retrieving data from 48 medical records of patients with sepsis, severe sepsis, and septic shock admitted to ICU Dr. Hasan Sadikin General Hospital (RSHS) in 2013. The study was conducted from August to October 2014. Empiric therapy in the ICUat RSHS and Surviving Sepsis Campaign (SSC) guidelines in 2012 were used as a standard for antibiotic prescription. The quality of antibiotic prescription was assessed then categorized based on Gyssens criteria. The collected data were analyzed in the form of frequency and percentage and presented in tables. Results: This study discovered that most of the patients had severe sepsis and septic shock. Based on Gyssens criteria, 35% antibiotic uses were included into category 0 (proper); 1.4% category I (improper timing); 10.5% category IIA (improper dosage); 9.1% category IIB (improper interval); 3.5% category IIC (improper route); 12.6% category IIIA (improper duration; too long); 1.4% category IIIB (improper duration; too short); 16.8% category IVA (improper; other antibiotics were more effective); 4.2% category IVD (improper; other antibiotics had narrower spectrum); and 5.6% category V (improper; no indication). Conclusions: There are still improper uses of antibiotic for sepsis, severe sepsis, and septic shock patients in the ICU. DOI: 10.15850/amj.v4n2.1088

Evaluation of antibiotic prescriptions for urinary tract infections in a geriatric rehabilitation unit.

Prescription of antibiotic in elderly patients must follow guidelines. to study the quality of antibiotic prescriptions for urinary tract infections (UTI) in the geriatric rehabilitation unit. Over a four-month period, all the antibiotics treatments prescribed for UTI in the rehabilitation ward were analyzed prospectively by medical experts and confronted with the recommendations of the local antibiotic guidelines. The methodology was based on Gyssens' algorithm. Treatments were considered appropriate if indication, choice of the molecule, duration and dose were approved by the experts, unnecessary if the indication was incorrect, and inappropriate in all other cases. The re-assessment of the prescription between 48 and 72 h was also evaluated. We reviewed 39 prescriptions. About half of all prescriptions (51.3%) was found to be unnecessary due to misdiagnosis, 16 prescriptions (41%) were considered inappropriate (2 for inadequate duration and 14 for inappropriate spectrum of activity, mainly with ceftriaxone prescriptions (9 cases)). Ten prescriptions (25.6%) were re-assessed between 48 and 72 hours after treatment initiation. According to this study, an improvement program was implemented. A diagnostic algorithm for UTI in elderly was drafted and will be integrated into the local guidelines. A supporting document for the re-assessment of the prescriptions 48-72h after treatment initiation was created. We decided to perform an evaluation of antibiotic prescriptions by the subcutaneous route.

Changing antibiotic prescribing in General Practice – The results of the SIMPle process evaluation

Objective: The Supporting the Improvement and Management of Prescribing for Urinary Tract Infections (SIMPle) study, a cluster randomized trial, sought to improve the quality of antibiotic prescribing for Urinary Tract Infections in General Practices located in the west of Ireland. This paper presents the process evaluation and intends to provide insights into the antibiotic prescribing behaviour of the General Practitioners (GPs) during the intervention. The paper discusses how the social marketing intervention developed as part of SIMPle resulted in GPs prescribing more first line antibiotics, the aim of the trial. However it also offers insights into why antibiotic prescriptions increased during the intervention period.Methods: Fifteen GP interviews and summative intervention components including monitoring practice participation and information provided to the study team. Thematic analysis was used to analyze transcripts.Results: GPs recognized the value of consultation coding to produce practice specific audit and feedback reports including current antibiotic prescribing and providing evidence which motivated change.Conclusions: The SIMPle study was successfully integrated into routine care. By simplifying GPs’ access to up to date evidence on their prescribing behaviors, GPs can be positively influenced beyond the context of an intervention.

Antibiotic prescribing in relation to diagnoses and consultation rates in Belgium, the Netherlands and Sweden: use of European quality indicators

Objective: To assess the quality of antibiotic prescribing in primary care in Belgium, the Netherlands and Sweden using European disease-specific antibiotic prescribing quality indicators (APQI) and taking into account the threshold to consult and national guidelines.Design: A retrospective observational database study.Setting: Routine primary health care registration networks in Belgium, the Netherlands and Sweden.Subjects: All consultations for one of seven acute infections [upper respiratory tract infection (URTI), sinusitis, tonsillitis, otitis media, bronchitis, pneumonia and cystitis] and the antibiotic prescriptions in 2012 corresponding to these diagnoses.Main outcome measures: Consultation incidences for these diagnoses and APQI values (a) the percentages of patients receiving an antibiotic per diagnosis, (b) the percentages prescribed first-choice antibiotics and (c) the percentages prescribed quinolones.Results: The consultation incidence for respiratory tract infection was much higher in Belgium than in the Netherlands and Sweden. Most of the prescribing percentage indicators (a) were outside the recommended ranges, with Belgium deviating the most for URTI and bronchitis, Sweden for tonsillitis and the Netherlands for cystitis. The Netherlands and Sweden prescribed the recommended antibiotics (b) to a higher degree and the prescribing of quinolones exceeded the proposed range for most diagnoses (c) in Belgium. The interpretation of APQI was found to be dependent on the consultation incidences. High consultation incidences were associated with high antibiotic prescription rates. Taking into account the recommended treatments from national guidelines improved the results of the APQI values for sinusitis in the Netherlands and cystitis in Sweden.Conclusion: Quality assessment using European disease-specific APQI was feasible and their inter-country comparison can identify opportunities for quality improvement. Their interpretation, however, should take consultation incidences and national guidelines into account. Differences in registration quality might limit the comparison of diagnosis-linked data between countries, especially for conditions such as cystitis where patients do not always see a clinician before treatment.Key pointsThe large variation in antibiotic use between European countries points towards quality differences in prescribing in primary care. • The European disease-specific antibiotic prescribing quality indicators (APQI) provide insight into antibiotic prescribing, but need further development, taking into account consultation incidences and country-specific guidelines. • The incidence of consultations for respiratory tract infections was almost twice as high in Belgium compared to the Netherlands and Sweden. • Comparison between countries of diagnosis-linked data were complicated by differences in data collection, especially for urinary tract infections.

Estimating the Impact of Post-Prescribing Review on the Quality of Antibiotic Prescribing in Skilled Nursing Facilities

Estimating the Impact of Post-Prescribing Review on the Quality of Antibiotic Prescribing in Skilled Nursing Facilities

Impact of Stewardship Intervention on Improving Antibiotic Prescribing Practices

Background: Antimicrobial stewardship programs (ASPs) have been found to be an effective method for minimizing antibiotic misuse. Method: A study comparing the quality of antibiotic prescriptions between a one-year period before ASP implementation and a one-year period after its implementation. For each period, antimicrobial prescriptions were evaluated by an antimicrobial stewardship team and classified as appropriate or inappropriate. Results: An improvement between Phase I and Phase II was found in all antibiotic therapies. Discussion: The overall antibiotic inappropriate rate was 45.8% before implemented the stewardship program, which is relatively high and consistent with the findings of other studies mentioned in the literature. Conclusion: Applying the stewardship program led to a significant decrease of the inappropriate use of antibiotics at the hospital.

Impact of an antimicrobial resistance control program: pre- and post-training antibiotic use in children with typhoid fever

Inappropriate use of antibiotics may lead to antimicrobial resistance. In 2012, Dr. Soetomo Hospital conducted training for pediatric residents on the proper use of antibiotics to limit antimicrobial resistance.Objective To evaluate the impact of a rational, antibiotic-use training program for pediatric residents on their antibiotic prescriptions for patients with typhoid fever.Methods A cross-sectional, analytic study was conducted. We collected data from children with typhoid fever who were hospitalized in Dr. Soetomo Hospital, pre- and post-training on antibiotic prescriptions. Children with other known bacterial infections or who were discharged on request were excluded. Antibiotic prescriptions were evaluated using Gyssens algorithm based on the local protocol. Chi-square test was used to compare the quality of antibiotic prescriptions, before (year 2012) and after (year 2013) the training.Results Forty-nine patients with 67 prescriptions in 2012 and 34 patients with 48 prescriptions in 2013 fulfilled the inclusion criteria. Patients’ ages ranged from 1-18 years. Diagnoses of uncomplicated and complicated typhoid were found in 74% and 26% of subjects, respectively. First line (chloramphenicol, thiamphenicol, ampicillin, trimetroprim and sulfametoxazol) and second line (ceftriaxone and cefixime) use were 72% and 28%, respectively. All patients were discharged in good condition. Appropriate use of antibiotics was noted in 61% of subjects in 2012 and in 81% of subjects in 2013 (P=0.036). The most common type of error in 2012 and 2013 was dosage imprecision (25% and 17%, respectively).Conclusion Training on appropriate use of antibiotics significantly improved the quality of antibiotics prescribed in children with typhoid fever in Dr. Soetomo Hospital.

Determinants of physician antibiotic prescribing behavior: a 3 year cohort study in Portugal

Objectives Antibiotic misprescription is a major driver of resistance, which is a worldwide public health problem. Therefore, our aim is to assess the influence of the determinants of physician prescribing on the quality of antibiotic use.Methods A 3 year cohort study including all primary-care physicians working in Portugal’s Central Regional Health Administration (n = 1094) was conducted. We assessed the determinants of prescribing using a pre-validated, personally addressed, reply-paid, self-administered questionnaire (sent four times to non-responders, between September 2011 and February 2012) designed to collect information on physicians’ attitudes to and knowledge of antibiotic prescribing as well as their socio-demographic and professional data. To evaluate antibiotic prescribing, we’ve calculated ESAC 12 quality indicators per physician per year, allowing us to stratify them as good or poor prescribers according to their performance on those indicators. Associations between determinants and outcomes were fitted with generalized linear mixed models.Results The overall response rate was 46.1%. Emergency activity (OR [95% CI] = 0.29 [0.16–0.54]; p < 0.05) and workload (number of patients seen per day: OR [95% CI] = 0.97 [0.94–1.00]; p < 0.05; number of patients seen per week in emergencies: OR [95% CI] = 0.98 [0.97–0.99]; p < 0.05) were both related to poor quality of antibiotic prescribing. Statistically significant odds ratios were also obtained for ignorance (IqOR [95% CI] = 2.14 [1.31–3.52]), complacency (1/IqOR [95% CI] = 1.19 [1.01–1.41]) and responsibility of others (1/IqOR [95% CI] = 1.78 [1.10–3.06]).Conclusions The above results serve to emphasize workload, working at emergency departments and physicians’ attitudes identified as critical factors affecting antibiotic prescribing. This provides new insights for clinicians, researchers and policy makers when it comes to developing and improving the clinical and economic outcomes of antibiotic use. Key limitations of the study included the difficulty of results extrapolation and the limitations of the stratification method based on the antibiotic prescribing quality indicators.

Effect of Physicians' Attitudes and Knowledge on the Quality of Antibiotic Prescription: A Cohort Study.

Resistance increases with the use and abuse of antibiotics. Since physicians are primarily responsible for the decision to use antibiotics, ascertaining the attitudes and knowledge that underlie their prescribing habits is thus a prerequisite for improving prescription. Three-year follow-up cohort study (2008–2010) targeting primary-care physicians (n = 2100) in Galicia, a region in NW Spain. We used data obtained from a postal survey to assess knowledge and attitudes. A physician was deemed to have demonstrated Appropriate Quality Prescription of Antibiotics (dependent variable) in any case where half or more of the indicators proposed by the European Surveillance of Antimicrobial Consumption had values that were better than the reference values for Spain. The mail-questionnaire response rate was 68·0% (1428/2100). The adjusted increase in the interquartile OR of displaying good prescribing of antibiotics for each attitude was: 205% for fear ("When in doubt, it is better to ensure that a patient is cured of an infection by using a broad-spectrum antibiotic"; 95%CI: 125% to 321%); 119% for better knowledge ("Amoxicillin is useful for resolving most respiratory infections in primary care"; 95%CI: 67% to 193%); and 21% for complacency with patients' demands ("Antibiotics are often prescribed due to patients' demands"; 95%CI: 0% to 45%). Due to the fact that physicians' knowledge and attitudes are potentially modifiable, the implementation of purpose-designed educational interventions based on the attitudes identified may well serve to improve antibiotic prescription.

Improving antibiotic prescribing quality by an intervention embedded in the primary care practice accreditation: the ARTI4 randomized trial.

Antibiotic overprescribing is a significant problem. Multifaceted interventions improved antibiotic prescribing quality; their implementation and sustainability, however, have proved difficult. We analysed the effectiveness of an intervention embedded in the quality cycle of primary care practice accreditation on quantity and quality of antibiotic prescribing for respiratory tract and ear infections (RTIs). This was a pragmatic, cluster-randomized intervention trial in 88 Dutch primary care practices. The intervention (physician education and audit/feedback on antibiotic prescribing quantity and quality) was integrated in practice accreditation by defining an improvement plan with respect to antibiotic prescribing for RTIs. Numbers and types of dispensed antibiotics were analysed from 1 year prior to the intervention to 2 years after the intervention (pharmacy data). Overprescribing, underprescribing and non-first-choice prescribing for RTIs were analysed at baseline and 1 year later (self-registration). There were significant differences between intervention and control practices in the changes in dispensed antibiotics/1000 registered patients (first year: -7.6% versus -0.4%, P = 0.002; second year: -4.3% versus +2%, P = 0.015), which was more pronounced for macrolides and amoxicillin/clavulanate (first year: -12.7% versus +2.9%, P = 0.001; second year: -7.8% versus +6.7%, P = 0.005). Overprescribing for RTIs decreased from 44% of prescriptions to 28% (P < 0.001). Most general practitioners (GPs) envisaged practice accreditation as a tool for guideline implementation. GP education and an audited improvement plan around antibiotics for RTIs as part of primary care practice accreditation sustainably improved antibiotic prescribing. Tools should be sought to further integrate and facilitate education and audit/feedback in practice accreditation.

Attitudes and perceptions of Dutch veterinarians on their role in the reduction of antimicrobial use in farm animals

Little is known about attitudes of veterinarians towards antibiotic use and reduction opportunities, and their interaction with farmers herein. Therefore, a questionnaire was developed and sent out to Dutch farm animal veterinarians. The response rate was 40%. Categorical Principal Component Analysis (CATPCA) was conducted on statements measuring attitudes towards the use of antibiotics and reduction opportunities in farm animals, the veterinary pharmacy and the interaction of veterinarians with farmers in improving animal health. This resulted in 3 underlying dimensions. Additionally, possible explanatory variables (main farm animal species working with, years of experience in practice) were added to the CATPCA to identify differences between veterinarians. Veterinarians working with different animal species were comparable in their opinions towards the necessity to reduce veterinary antibiotic use and the current policy to halve veterinary antibiotic consumption. Veterinarians working with ruminants – “ruminant specialists” – and veterinarians working with several different animal species – “generalists” – reported to feel more uncertainty in acting independently from farmers' and significant others' (other advisors, colleagues) demands for antibiotics or opinions than veterinarians mainly working with intensively raised animals (pigs, poultry, veal calves) – “intensive specialists”. Years of experience in practice was negatively related to feelings of uncertainty in acting independently. At the other hand, years of experience was associated with being less concerned about the possible contribution of veterinary antibiotic use to antimicrobial resistance, considering it more important to keep the right to prescribe and sell antibiotics, and being less hesitant to apply antibiotics to prevent (further dissemination of) animal diseases. Intensive specialists expected most from improving feed quality and benchmarking of antibiotic prescribing and use in reducing veterinary antibiotic use; ruminant specialists and generalists preferred improving housing and climate conditions and benchmarking. The by veterinarians perceived main reasons for farmers not to comply to veterinary advices to improve animal health were related to financial and time restrictions, although intensive specialists stressed the importance of conflicting advices from other advisors as a cause for non-compliance. The results showed that younger veterinarians might require additional support to act independently from farmers’ and significant others’. Additionally, experienced veterinarians could be educated about possible risks related to veterinary overuse of antibiotics. Alternative approaches should be identified for veterinarians to preserve a decent income without pharmacy incomes. Especially in intensive farming, ways should be found to prevent contradictory advices as a barrier not to implement veterinary advices to improve animal health.