Original Scientific Article
Pet owners’ knowledge, attitudes, and practices regarding antimicrobial use and antimicrobial resistance in companion animals in North Macedonia
Ivana Shikoska * ,
Jane Vlahov ,
Boris Dimitrievski ,
Bojana Chapkunovska ,
Ljubica Rashikj ,
Mirko Prodanov ,
Martin Nikolovski ,
Elena Atanaskova Petrov ,
Aleksandar Cvetkovikj ,
Iskra Cvetkovikj

Mac Vet Rev 2026; 49 (2): i - xiv

10.2478/macvetrev-2026-0026

Received: 12 March 2026

Received in revised form: 28 April 2026

Accepted: 23 June 2026

Available Online First: 02 October 2026

Published on: 15 October 2026

Correspondence: Ivana Shikoska, ivana@fvm.ukim.edu.mk
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Abstract

Antimicrobial use (AMU) in companion animals is influenced not only by veterinary prescribing practices but also by pet owners, whose decisions on medication administration, compliance, and expectations can impact antimicrobial stewardship and antimicrobial resistance (AMR) at the human–animal interface. This study aimed to assess pet owners’ knowledge, attitudes, and practices regarding AMU and AMR in companion animals in North Macedonia. A cross-sectional, web-based questionnaire was completed by 410 pet owners in North Macedonia. Data was analysed using descriptive and inferential statistics. Of the respondents, 96.3% (395/410) acknowledged AMR as a serious health challenge, indicating high general awareness. However, this awareness did not consistently translate into accurate knowledge and recommended practices. For example, while 92.4% (379/410) identified bacteria as a target of antibiotic therapy, only 67.1% (275/410) chose bacteria as the only correct answer. Regarding interspecies transmission, 66.6% (273/410) agreed that companion animals may transmit antimicrobial-resistant bacteria to humans, while 60.2% (247/410) were previously aware of such transmission. Trust in veterinarians was high, but 36.1% (148/410) of respondents still expected antibiotic therapy for a wide range of clinical conditions. Additionally, 44.1% (181/410) reported administering antibiotics intended for human use to their pets, and 62.9% (258/410) reported keeping antibiotics at home “just in case.” Knowledge of bacteriological testing was associated with adherence to the prescribed treatment duration. These findings indicate that, despite high general awareness of AMR, important gaps remain in pet owners’ specific knowledge and practices. Pet owners should be considered an important target for antimicrobial stewardship efforts in small animal practice in North Macedonia.

Keywords: antibiotics, antimicrobial stewardship, awareness, small animal practice, AST

References

1. World Health Organization (2025). Global antibiotic resistance surveillance report 2025: WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS). Geneva: World Health Organization[A1.1] https://doi.org/10.2471/B09585 
2. Mader, R., Demay, C., Jouvin-Marche, E., Ploy, M.C., Barraud, O., Bernard, S., et al. (2022). Defining the scope of the European Antimicrobial Resistance Surveillance network in veterinary medicine (EARS-Vet): a bottom-up and One Health approach. J Antimicrob Chemother. 77(3): 816-826.
3. European Medicines Agency (2025). European sales and use of antimicrobials for veterinary medicine (ESUAvet): annual surveillance report for 2023. Amsterdam: European Medicines Agency[A2.1]
4. Zhao, R., Hao, J., Yang, J., Tong, C., Xie, L., Xiao, D., Zeng, Z., Xiong, W. (2022). The co-occurrence of antibiotic resistance genes between dogs and their owners in families. Imeta. 1(2): e21. https://doi.org/10.1002/imt2.21 PMid:38868570
5. Kovačević, Z., Gračner, G.G., Tomanić, D., Vlahović, K., Šarić, L., Novaković, D., et al. (2025). Compounding and use of human medicinal products in small animal practice: what are the perspectives  of veterinarians?-A pilot study. Vet Sci. 12(9): 914. https://doi.org/10.3390/vetsci12090914 PMid:41012840 PMCid:PMC12474484
6. Marco-Fuertes, A., Marin, C., Lorenzo-Rebenaque, L.,  Vega, S., Montoro-Dasi, L. (2022). Antimicrobial  resistance in companion animals: a new challenge for the One Health approach in the European Union.  Vet Sci. 9(5): 208. https://doi.org/10.3390/vetsci9050208 PMid:35622736 PMCid:PMC9146952
7. European Medicines Agency (2019). Categorisation of antibiotics in the European Union. Amsterdam: European Medicines Agency[A3.1]
8. Caneschi, A., Bardhi, A., Barbarossa, A., Zaghini, A. (2023). The use of antibiotics and antimicrobial resistance in veterinary medicine, a complex phenomenon: a narrative review. Antibiotics (Basel). 12(3): 487. https://doi.org/10.3390/antibiotics12030487 PMid:36978354 PMCid:PMC10044628
9. Hardefeldt, L.Y., Holloway, S., Trott, D.J., Shipstone, M., Barrs, V.R., Malik, R., et al. (2017). Antimicrobial prescribing in dogs and cats in Australia: results of the Australasian infectious disease advisory panel survey. J Vet Intern Med. 31(4): 1100-1107. https://doi.org/10.1111/jvim.14733 PMid:28514013 PMCid:PMC5508328
10. Shikoska, I., Cvetkovikj, A., Nikolovski, M., Cvetkovikj, I. (2024). Understanding antimicrobial prescription practices: Insights from small animal veterinarians in North Macedonia. Mac Vet Rev. 47(2): 103-114. https://doi.org/10.2478/macvetrev-2024-0020 
11. Monteiro, H.I.G., Silva, V., de Sousa, T., Calouro, R., Saraiva, S., Igrejas, G., Poeta, P. (2025). Antimicrobial resistance in European companion animals practice: a One Health approach. Animals. 15(12): 1708. https://doi.org/10.3390/ani15121708 PMid:40564260 PMCid:PMC12189186
12. Grönthal, T., Österblad, M., Eklund, M., Jalava, J., Nykäsenoja, S., Pekkanen, K., et al. (2018). Sharing more than friendship - transmission of NDM-5 ST167 and CTX-M-9 ST69 Escherichia coli between dogs and humans in a family, Finland, 2015. Euro Surveill. 23(27): 1700497. https://doi.org/10.2807/1560-7917.ES.2018.23.27.1700497 PMid:29991384 PMCid:PMC6152158
13. Dickson, A., Smith, M., Smith, F., Park, J., King, C., Currie, K., et al. (2019). Understanding the relationship between pet owners and their companion animals as a key context for antimicrobial resistance-related behaviours: an interpretative phenomenological analysis. Health Psychol Behav Med. 7(1): 45-61. https://doi.org/10.1080/21642850.2019.1577738 PMid:34040838 PMCid:PMC8114347
14. Hopman, N.E.M., Hulscher, M.E.J.L., Graveland, H., Speksnijder, D.C., Wagenaar, J.A., Broens, E.M. (2018). Factors influencing antimicrobial prescribing by Dutch companion animal veterinarians: A qualitative study. Prev Vet Med. 158, 106-113. https://doi.org/10.1016/j.prevetmed.2018.07.013 PMid:30220383
15. Smith, M., King, C., Davis, M., Dickson, A., Park, J., Smith, F., et al. (2018). Pet owner and vet interactions: Exploring the drivers of AMR. Antimicrob Resist Infect Control. 7, 46. https://doi.org/10.1186/s13756-018 0341-1 PMid:29619213 PMCid:PMC5879597
16. Aithal, S., Guo, H., Teo, B.H., Chua, T., Hildon, Z.J.-L., Chow, A. (2025). Pet owners' knowledge of antibiotic use and antimicrobial resistance and their antibiotic practices: comparison between contexts of self and pet. Antibiotics (Basel). 14(2): 158. https://doi.org/10.3390/antibiotics14020158 PMid:40001402 PMCid:PMC11851957
17. Scarborough, R.O., Sri, A.E., Browning, G.F., Hardefeldt, L.Y., Bailey, K.E. (2023). 'Brave enough': a qualitative study of veterinary decisions to withhold or delay antimicrobial treatment in pets. Antibiotics (Basel). 12(3): 540. https://doi.org/10.3390/antibiotics12030540 PMid:36978407 PMCid:PMC10044613
18. Dias, M.C., Alpizar-Jara, R., Lavrador, C., Marques, C., Broens, E.M., Duarte, E.L. (2024). Companion animal owners' knowledge, attitudes and perceptions regarding antibiotic use in Portugal. Antibiotics. 13(6): 533. https://doi.org/10.3390/antibiotics13060533 PMid:38927199 PMCid:PMC11201214
19. Frey, E., Kedrowicz, A., Hedgpeth, M.W. (2022). Exploring companion animal caretakers' attitudes, perceptions and behavioural drivers of antimicrobial use within the social context of veterinary care. J Small Anim Pract. 63(12): 873-881. https://doi.org/10.1111/jsap.13549 PMid:36084956 PMCid:PMC10086989
20. Arnecke, A.L., Schwarz, S., Lübke-Becker, A., Jensen, K.C., Bahramsoltani, M. (2024). A Survey on companion animal owners' perception of veterinarians' communication about zoonoses and antimicrobial resistance in Germany. Animals (Basel). 14(22): 3346. https://doi.org/10.3390/ani14223346 PMid:39595398 PMCid:PMC11590884
21. Scarborough, R., Hardefeldt, L., Browning, G., Bailey, K. (2021). Pet owners and antibiotics: knowledge, opinions, expectations, and communication preferences. Antibiotics (Basel). 10(11): 1326. https://doi.org/10.3390/antibiotics10111326 PMid:34827264 PMCid:PMC8615269
22. Redding, L.E., Cole, S.D. (2019). Pet owners' knowledge of and attitudes toward the judicious use of antimicrobials for companion animals. J Am Vet Med Assoc. 254(5): 626-635. https://doi.org/10.2460/javma.254.5.626 PMid:30779623
23. Candellone, A., Badino, P., Girolami, F., Ala, U., Mina, F., Odore, R. (2023). Dog owners' attitude toward veterinary antibiotic use and antibiotic resistance with a focus on canine diarrhea management. Animals (Basel). 13(6): 1061. https://doi.org/10.3390/ani13061061 PMid:36978602 PMCid:PMC10044205
24. Stallwood, J., Shirlow, A., Hibbert, A. (2020). A UK-based survey of cat owners' perceptions and experiences of antibiotic usage. J Feline Med Surg. 22(2): 69-76. https://doi.org/10.1177/1098612X19826353 PMid:30720397 PMCid:PMC10814557
25. Wang, X., Lin, L., Xuan, Z., Li, L., Zhou, X. (2018). Keeping antibiotics at home promotes self-medication with antibiotics among Chinese university students. Int J Environ Res Public Health. 15(4): 687. https://doi.org/10.3390/ijerph15040687 PMid:29621165 PMCid:PMC5923729
26. Allerton, F., Prior, C., Bağcıgil, A.F., Broens, E.M., Callens, B., Damborg, P., et al. (2021). Overview and evaluation of existing guidelines for rational antimicrobial use in small-animal veterinary practice in Europe. Antibiotics (Basel). 10(4): 409. https://doi.org/10.3390/antibiotics10040409 PMid:33918617 PMCid:PMC8069046
27. Galarce, N., Dumont-Viollaz, A., Longa, J., del Río, L.C., Núñez, A., Guzmán-Marín, B., Thomson, P. (2025). Perceptions of antimicrobial use and resistance among pet owners in Chile: A cross-sectional One Health survey. Vet World. 18(8): 2450-2459. https://doi.org/10.14202/vetworld.2025.2450-2459 PMid:41064845 PMCid:PMC12501537
28. Wright, E., Jessen, L.R., Tompson, A., Rutland, C., Singleton, D., Battersby, I., et al. (2024). Influencing attitudes towards antimicrobial use and resistance in companion animals-the impact on pet owners of a short animation in a randomized controlled trial. JAC Antimicrob Resist. 6 (3): dlae065. https://doi.org/10.1093/jacamr/dlae065 PMid:38716404 PMCid:PMC11073752
29. Tomanic, D., Stojanovic, D., Belić, B., Davidov, I., Novakov, N., Radinovic, M., et al. (2021). Off label use of human approved drugs in treatment of dogs in the Republic of Serbia. Pol J Vet Sci. 24(3): 399-407. https://doi.org/10.24425/pjvs.2021.138731 PMid:34730304
30. Shikoska, I., Duvnjak, S., Koritnik, T., Chapkunovska, B., Vlahov, J., Ratkova Manovska, M., Cvetkovikj, A., Cvetkovikj, I. (2025). Extended-spectrum β-Lactamase-/AmpC-Producing Escherichia coli and associated risk factors in shelter dogs: a baseline study in North Macedonia. Microbiol Res. 16(9): 206. https://doi.org/10.3390/microbiolres16090206 
31. Shikoska, I., Hristovska, Z.P., Matevski, I., Pavlova, M.J., Manovska, M.R., Cvetkovikj, A., Cvetkovikj, I. (2025). Phenotypic and molecular characterization of antimicrobial resistance in canine Staphylococci from North Macedonia. Mac Vet Rev. 48 (2): 159-172. https://doi.org/10.2478/macvetrev-2025-0022 
32. Stein, M.R., Weese, J.S., Stull, J.W., McClure, J.T., Evason, M. (2022). Knowledge, attitudes and influencers of cat owners in North America around antimicrobials and antimicrobial stewardship. J Feline Med Surg. 24(6): e90-e97. https://doi.org/10.1177/1098612X221090456 
33. Chadborn, T., Williams, S., Jorgensen, T., Price, C., Buckel, A., Altieri, E. (2023). An approach for embedding behavioural science in antimicrobial resistance One Health research. J Infect Public Health. 16 (Suppl 1): 134 140. https://doi.org/10.1016/j.jiph.2023.11.001 PMid:37973498


Copyright  

©2026 Shikoska I. This is an open-access article published under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Conflict of Interest Statement

The authors declared that they have no financial or non-financial conflict of interest regarding authorship and publication of this article.

Citation Information

Macedonian Veterinary Review. Volume 49, Issue 2, Pages i-xiv, e-ISSN 1857-7415, p-ISSN 1409-7621, DOI:  https://doi.org/10.2478/macvetrev-2026-0026

The all content of the Macedonian Veterinary Review, except where otherwise noted, is licensed under a Creative Commons Attribution License.