%0 Journal Article
%T Antimicrobial Stewardship at the Point of Veterinary Decision-Making: Integrating Diagnostic Certainty, Time-to-Harm, Host Vulnerability, Treatment Burden, Resistance Risk, and Reassessment Into Clinically Defensible Prescribing
%A Hans Müller
%A Anna Schmidt
%A Thomas Weber
%J International Journal of Veterinary Research and Allied Sciences
%@ 3062-357X
%D 2025
%V 5
%N 2
%R 10.51847/I1WvurWk9Y
%P 11-21
%X Veterinary antimicrobial prescribing frequently requires action before all relevant uncertainties are resolved. Decisions must reconcile the probability that bacterial disease is present, the consequences of delaying effective therapy, host vulnerability, infection-site pharmacology, treatment feasibility, and the wider resistance implications of antimicrobial exposure. Existing stewardship guidance addresses many of these considerations, but they are often encountered as separate recommendations rather than as a unified point-of-care decision problem. This original non-empirical article develops a proposed multidimensional stewardship architecture for clinically defensible prescribing across companion-, farm-, and mixed-animal practice. The synthesis treats diagnostic certainty, time-to-harm, host vulnerability and disease severity, expected antimicrobial exposure at the infection site, treatment burden and practical feasibility, and individual-versus-population resistance risk as analytically distinct but interacting domains. It further argues that empirical treatment should be considered a revisable state rather than a terminal decision, with culture, susceptibility, clinical response, and new diagnostic information capable of supporting continuation, modification, de-escalation, escalation, or discontinuation. The architecture deliberately avoids converting heterogeneous evidence into an unsupported numerical score. Instead, it emphasizes noncompensatory constraints, conditional strategies, explicit uncertainty, and mandatory reassessment. Its intended contribution is conceptual organization rather than prospective prediction or proof of improved clinical, welfare, or public-health outcomes. Validation will require disease-, species-, and setting-specific prospective testing, attention to diagnostic access and treatment feasibility, and evaluation of both animal-level outcomes and stewardship consequences.
%U https://esvpub.com/article/antimicrobial-stewardship-at-the-point-of-veterinary-decision-making-integrating-diagnostic-certain-fy8k7adq7mvase8