Current evidence indicates that more than half of all antimicrobials are used in the animal food-producing sector, which is considered a significant risk factor for the development, spread, and existence of antimicrobial resistance (AMR) pathogens in animals, humans, and the environment. Among other factors, clinical etiology and the level of knowledge, attitudes, and practices (KAP) of veterinarians are thought to be responsible for inappropriate prescriptions in the animal-source protein production sector in lower-resource settings like Bangladesh. We performed this cross-sectional study to assess factors associated with veterinarians’ antimicrobial prescription behavior and their KAP on antimicrobial use (AMU) and AMR in Bangladesh. Exploratory and multivariate logistic models were used to describe an association between knowledge, attitudes, and practices of AMU and AMR and demographic characteristics of veterinarians. The results demonstrated that when selecting an antimicrobial, there was no to minimal influence of culture and susceptibility tests and patients’ AMU history but moderate to high influence of the farmer’s economic condition and drug instructions among the veterinarians. The results also demonstrated that more than half of the veterinarians had correct KAP regarding AMU and AMR, while the rest had moderate or lower levels of KAP. The factor score analysis revealed that age, level of education, years of experience, gender, and previous training on AMU and AMR were the key influencing factors in their level of KAP. Adjusted logistic regression analysis showed that respondents’ age, current workplace, and previous training on AMU and AMR had a positive association with increased KAP. Considering the results, it is imperative to include AMR issues on vet curricula, and to provide post-education training, awareness campaigns, easy access to, and dissemination of AMR resources. Increasing the veterinary services to the outreach areas of the country and motivating veterinarians to follow the national AMR guidelines could be some other potential solutions to tackle the over-prescriptions of antimicrobials.

The integration of behavioral theories in designing antimicrobial stewardship (AMS) interventions aimed at optimizing the antimicrobial prescription in veterinary practice is highly recommended. However, little is known about the factors that influence veterinarians’ antimicrobial behavior for food-producing animals in lower- and middle-income settings like Bangladesh. There is a large body of research on the factors that influence veterinarian behavior of prescribing antimicrobials, however, there is a need for more studies that use comprehensive behavior change models to develop and evaluate interventions. Applying the Capability, Opportunity, and Motivation for Behavior (COM-B) model, this qualitative study attempted to address this gap by conducting 32 one-on-one semi-structured interviews with registered veterinarians in Bangladesh. In alignment with COM-B constructs and the theoretical domain framework (TDF), thematic analysis (both inductive and deductive inferences) was performed to analyze the data and identify underlying factors that influence veterinarians’ antimicrobial prescription behavior. We found that under "Capability,” factors such as knowledge of antimicrobial resistance (AMR); ability to handle complex disease conditions; ability to identify the appropriate antimicrobial type, routes of administration, and potential side effects influence prescription behavior by veterinarians. Under “Opportunity,” veterinarians’ prescription behavior was influenced by lack of laboratory testing facilities, poor farm biosecurity, farm management and location, farming conditions, impacts of climate change, the clinical history of animals and social influence from different actors including senior figures, peers, farmers, and other informal stakeholders. Under “Motivation,” national laws and guidelines serve as catalysts in reducing antimicrobial prescriptions. However, perceived consequences such as fear of treatment failure, losing clients, farmers’ reliance on informal service providers, and economic losses demotivate veterinarians from reducing the prescription of antimicrobials. Additionally, veterinarians feel that reducing the burden of AMR is a shared responsibility since many informal stakeholders are involved in the administration and purchase of these medicines. Based on our results, this study recommends incorporating the factors we identified into existing or novel AMS interventions. The behavior change wheel can be used as the guiding principle while designing AMS interventions to increase capability, opportunity and motivation to reduce antimicrobial over-prescription.