Abstract
Background:
While veterinarians have practiced telemedicine in various forms for years, the arrival of reliable, synchronous videoconferencing has increased the use of telemedicine for care delivery, a trend accelerated by the COVID-19 pandemic. However, data are sparse on antimicrobial drug (AMD) prescription practices in this setting.

Aim:
This assessment looked at AMD prescription practices among veterinarians using a telemedicine platform for care delivery in the United States.

Methods:
We surveyed U.S. veterinarians online about their most recent telemedicine appointment using association and veterinary college mailing lists and social media veterinary group. Demographic information was collected along with information on the species of the animal, the chief complaint, treatment recommendations, and the type of telemedicine platform used, and if the pet owner discussed AMDs during the appointment prior to a recommendation being made.

Results:
A total of 88 veterinarians from 25 U.S. states responded to the survey. Of the 88 telemedicine appointments, 15% (13) resulted in a prescription for an oral antibiotic. AMDs were prescribed for 5% (2/37) of canines and 25% (5/20) of felines; and for a variety of complaints including ear/nose/throat, dermatologic, ophthalmic, respiratory, musculoskeletal, and gastrointestinal complaints. Veterinarians with <15 years in practice prescribed AMDs more frequently than those practicing for ≥15 years (23%; 10/44 versus 8%; 2/25). No veterinarian prescribed oral AMDs during email or text only or telephone only appointments. Most (54%; 46/85) veterinarians reported the pet owner requesting or raising antibiotic therapy prior to any recommendation by the veterinarian. Of these, 22% (10/46) were prescribed an oral AMD compared to 8% (3/39) of those who did not (p=0.07).

Conclusion:
AMD prescribing rates in this assessment of telemedicine appointments were comparable to that reported for in-person visits in the United States. Veterinarians with fewer years of experience were more likely to prescribe AMDs during a telemedicine visit, suggesting a higher level of comfort with prescribing among younger veterinarians and highlighting the need for continued education around telemedicine and antimicrobial stewardship.

Key words: Antimicrobials, Telemedicine, Prescription, Resistance, Stewardship