Veterinary antimicrobial prescribing tracks diagnosis in Bhutan district records

A retrospective analysis of routine veterinary clinical records from Mongar district in eastern Bhutan has linked antimicrobial prescribing to recorded diagnoses at the individual-animal level, a connection rarely captured in resource-limited settings. The study, published in BMC Veterinary Research, covered 8,881 clinical visits and 1,063 antimicrobial line items recorded between January 2023 and June 2026 at the District Veterinary Hospital and 16 Renewable Natural Resources Extension Centres.

Of the 8,881 visits, 1,022, or 11.51 percent, resulted in an antimicrobial prescription. The pharmacological class chosen differed by the recorded diagnosis system, with a Cramér’s V of 0.26, indicating a small-to-moderate association. Tetracyclines predominated in cattle, while penicillins were the leading class in dogs and cats. Prescribing proportions by diagnosis ranged from 0 percent to 80 percent against an overall baseline of 11.3 percent, though the authors caution that small diagnostic groups carried wide confidence intervals. Urinary tract infection, for example, showed a prescribing proportion of 80.0 percent (95% CI 60.9–91.1) based on only 25 cases.

The analysis also examined documentation of course-completion advice, a key stewardship indicator, by WHO AWaRe tier. Advice was documented for 55.7 percent of Access-tier line items but only 23.7 percent of Watch-tier items, a difference of 32.1 percentage points (95% CI 25.6–37.9). After adjusting for route of administration in the single primary logistic regression model, the Watch-versus-Access odds ratio was 0.71 (95% CI 0.48–1.04), a result compatible with either a substantial reduction or no difference. Exploratory route-specific analyses suggested the gap was concentrated in injectable and other non-oral items, with an odds ratio of 0.45 (95% CI 0.25–0.78), while oral items showed an odds ratio of 1.30 (95% CI 0.68–2.72).

The authors stress that these are diagnosis-associated prescribing patterns, not evidence of prescribing appropriateness. No clinical or microbiological outcome data were available in the records, so the study cannot determine whether any prescription was correct for the condition treated. Similarly, the course-completion indicator measures only what was written in the record, not whether or how well clients were actually advised, making the finding best interpreted as a documentation gap that structured recording could address.

The analysis included a sensitivity check showing that the difference in Watch-tier share between food-producing and companion animals reversed if oxytetracycline was classified as an Access-tier drug, underscoring how classification choices can shape stewardship metrics. The study addresses a gap identified in Bhutan’s National Action Plan on Antimicrobial Resistance and is, according to the authors, among few studies from Bhutan to link diagnosis, antimicrobial selection and documented client advice within routine veterinary records. Methods relied on proportions with Wilson 95 percent confidence intervals, Cramér’s V, and the route-adjusted regression, with all other analyses treated as secondary or exploratory.

Subject of Research: Antimicrobial prescribing patterns linked to recorded diagnoses in Bhutanese district veterinary records

Article Title: Diagnosis-associated antimicrobial prescribing patterns in a resource-limited veterinary district setting: evidence from Mongar, Bhutan (2023–2026)

Article References: Pokhrel, N., & Cheda, C. (2026). Diagnosis-associated antimicrobial prescribing patterns in a resource-limited veterinary district setting: evidence from Mongar, Bhutan (2023–2026). BMC Veterinary Research. https://doi.org/10.1186/s12917-026-06054-x

Image Credits: AI Generated

DOI: 10.1186/s12917-026-06054-x

Keywords: antimicrobial resistance, veterinary medicine, Bhutan, prescribing patterns, WHO AWaRe, antimicrobial stewardship, retrospective records, Mongar, livestock, companion animals, course-completion advice, one health