Antimicrobial use (AMU) in Switzerland is above target and requires reduction, especially in dairy cattle. Measuring AMU is pivotal to identifying starting points for AMU reduction, and so are studies investigating its potential drivers in dairy farms worldwide. However, although AMU in dairy farms is high, studies estimating AMU specifically in tiestall farms are scarce. Tiestalls are a common housing system and their prevalence among dairy farms accounts to approximatively 73%, 41%, and 40% in Canada, the United States, and Switzerland, respectively. The objectives of this cross-sectional, retrospective observational study were to estimate AMU using the newly established Swiss national reporting system for AMU in livestock and to identify associated factors on Swiss tiestall dairy farms. We calculated the treatment incidence (TI) by using the European Medicines Agency methodology and their defined daily dose (DDD) and defined course dose (DCD) standards. Data on factors potentially associated with AMU were obtained through personal interviews with farm managers on 221 farms. Retrospectively, during a 1-year period, data on a total of 7,619 treatments were extracted from the national database. Associations between management factors and TI were analyzed using a generalized linear model with gamma distribution. The mean (± SD) overall TI was 5.46 DDD/cow-year (± 4.10 DDD/cow-year). Intramammary treatment during lactation accounted for highest TI (3.24 ± 3.16 DDD/cow-year), whereas dry-cow therapy accounted for lowest TI (0.44 ± 0.49 DCD/cow-year). We found that 5 of the investigated management factors were significantly associated with TI. Organic production (estimate = -2.16; 95% CI = -3.62 to -0.70) and herd size (estimate = -0.81; 95% CI = -1.23 to -0.39) were negatively associated with TI. Specific cow breeds (Brown Swiss estimate = 1.56; 95% CI = 0.45-2.68) and Holstein Friesian (estimate = 1.42; 95% CI = 0.03-2.82; reference: other breeds) and the use of hygienic powders on the lying area (estimate = 1.10; 95% CI = 0.04-2.17) were positively associated with TI. Overall, the Swiss national reporting system is a valuable tool for AMU estimation. Several herd characteristics and management factors were associated with AMU in tiestall farms. Further studies focusing on factors associated with AMU and which are amenable to intervention will help improve stewardship programs and subsequently reduce AMU in dairy cows.