District-level trends in veterinary antimicrobial prescribing in a resource-limited setting: evidence from Mongar, Bhutan (2023–2026)

Abstract Background Antimicrobial resistance (AMR) is an increasing One Health problem, and there is very limited surveillance data from veterinary services in low- and middle-income countries. In Bhutan, District Veterinary Hospital and Renewable Natural Resources Extension Centres (RNR-EC) routinely record prescribing data in the Veterinary Information System database, but these data were hardly analysed for antimicrobial use (AMU) trends. This study outlines trends in antimicrobial prescribing at DVH Mongar and extension centres across Mongar District, Bhutan, for a period of 3.5 years. Methods We conducted a retrospective analysis of clinical veterinary data from DVH Mongar and 16 RNR-Extension Centres that serve 17 gewogs (the district's sub-administrative units). The analysis covered the period from January 2023 to June 2026. Clinical records were downloaded from the district's Veterinary Information System (VIS), merged across four annual exports, and cleaned. Antimicrobial prescriptions were identified by the Medicine Class field and analyzed for trends by species, and by prescribing facilities over time. Results A total of 1,063 antimicrobial prescriptions (6.1%) were identified out of 17,482 clinical records (individual drug/procedure line items). At the visit level (unique patient-date combinations), at least one antimicrobial was prescribed during 1,022 of 8,881 total visits (11.5%). No significant prescribing trend was seen from 2023 to mid-2026 even after adjusting for seasonality (monthly trend p = 0.987; seasonality-adjusted p = 0.939). Tetracyclines (39.5%) and Penicillins (35.3%) made up 75% of prescriptions. Antimicrobial class differed significantly by species (χ²=403.25, p < 0.001) and by facility type even after controlling for species (χ²=56.96, p < 0.001), with DVH Mongar preferring Penicillins and RNR-Extension Centres preferring Sulphonamides and Aminoglycosides. Antimicrobial prescription numbers peaked significantly from June to August, aligning with the monsoon season (χ²=59.37, p < 0.001). Conclusions In a study period of 3.5 years, antimicrobial prescribing in DVH Mongar and Renewable Natural Resources Extension Centres has remained stable, and Tetracyclines and Penicillins were found to be the highest prescribed antimicrobials. Significant species and facility-level differences in antimicrobial class choice and a prominent seasonal peak. These findings recommend specific and actionable targets for antimicrobial stewardship planning in this resource-limited district veterinary setting.