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VetVine Client Care

Posted On Sep 16, 2025

Updated On Sep 16, 2025

When “Watchful Waiting” Is The Best Medicine

Antimicrobial Stewardship

Antimicrobial resistance isn’t just a global health issue—it’s something we see in practice every day when culture results come back with limited or no effective options. Resistant infections mean longer recovery times, higher costs for clients and, in some cases, no good treatment choices at all. The good news? Small, deliberate changes in how we prescribe and manage antibiotics can make a big difference. That’s the heart of antimicrobial stewardship: protecting the effectiveness of these life-saving drugs while still giving our patients the best possible care.

There are several common conditions in small animal medicine where antimicrobial stewardship priniciples have been more recently adopted. Furthermore, restraint in prescribing often results in equal outcomes for patients; it also benefits clients as well as the broader community (from a One Health perspective).

Common conditions that don't always require antibiotics include:

  1. Canine Infectious Respiratory Disease Complex (Kennel Cough): While that harsh, hacking cough may be alarming to pet owners, in otherwise healthy dogs, most cases resolve within a couple of weeks with supportive care alone. Unless fever or systemic illness is present, antibiotics are usually unnecessary.

  2. Feline Upper Respiratory Infections: Most upper respiratory infections in cats are viral in origin. If the illness has lasted less than 10 days and the cat is still eating, supportive care — such as warming food to enhance palatability — is often sufficient. Antibiotics should be reserved for complicated or prolonged cases.

  3. Acute Diarrhea: Diarrhea is one of the most common reasons for clients to pay a visit to the veterinarian with a desire to “please fix this now!” Yet, in the vast majority of otherwise healthy animals, acute diarrhea often resolves on its own. Supportive care, dietary modification, hydration, and probiotics are often as effective (if not moreso) — and safer for the microbiome — than reaching for metronidazole or other antimicrobials.

Why does this all matter? Every antimicrobial prescription has ripple effects beyond the target pathogen. Disruption of the gut microbiome, or dysbiosis, is linked not just to digestive issues but also to immune health, metabolic balance, and even behavior.

Research shows that:

  • Antibiotics can cause decreases in beneficial bacteria and increases in pathogenic species like E. coli or Clostridium.
  • The gut microbiome may remain altered for months, or even up to a year, after a short course of antibiotics (e.g. ciprofloxacin).
  • In many cases, antimicrobials like metronidazole offer little benefit over placebo in resolving acute diarrhea — while probiotics may be equally or more effective.


Reframing the Approach: From “Treat Now” to “Treat Right”

In cases like acute diarrhea, the goal should not be focused on just stopping symptoms quickly, but to restore a healthy, resilient gut microbiome. This often means:

  • Choosing supportive care first.
  • Using prebiotics and probiotics to feed beneficial bacteria and encourage long-term gut health.
  • Reserving antimicrobials for clearly diagnosed bacterial infections or truly severe cases.


A Natural Entry Point for Stewardship

For many clinics, acute diarrhea represents the “low-hanging fruit” in antimicrobial stewardship. Updating protocols in this area requires little investment, aligns with evidence-based guidelines, and allows teams to practice and model stewardship principles in a high-volume, familiar condition.

Diagnostics: Strengthening Stewardship

Another cornerstone of stewardship is a commitment to diagnostics:

  • Cultures may not be necessary for a first uncomplicated urinary tract infection, but they are essential in recurrent cases.
  • Cytology can guide empiric therapy and improve interpretation of culture results.
  • Evidence-based guidelines, such as those from AVMA, provide practical “dos and don’ts” for common conditions and can serve as helpful client communication tools.

 

Stewardship is not just about withholding treatment — it’s about ensuring that when antimicrobials are used, they are used wisely, effectively, and only when truly necessary. By adopting watchful waiting, prioritizing diagnostics, and focusing on microbiome health, veterinarians can protect the efficacy of these life-saving drugs for years to come.

We are pleased to offer these select topics On Demand that meet antimicrobial stewardship CE requirements:


Registrants will be provided a downloadable packet of supplemental materials including:

  • Handbook of Antimicrobial Stewardship in Companion Animal Veterinary Settings
  • Pocket guide: Antimicrobial prescribing for common small animal diseases
  • Checklist for Core Principal Implementation
  • Antibiotic Use Talking Points for Vet Clinics
  • "No Antibiotic Today" Handout / Prescription - a fillable PDF that can be provided to clients in lieu of a vial of pills (when antimicrobials are not indicated)