Simple Summary: Quantifying antimicrobial use (AMU) in livestock using dose-based methods is useful for identifying potential risk factors related to AMU and to promote responsible AMU. Herewith, we investigated the temporal patterns and effects of several structural and management factors on AMU in a sample of pig farms in northern Italy during a period of three years. Overall, AMU showed a large variability between farms and no significantly decreasing trend. However, in several farms, a significant AMU reduction of up to two-thirds was observed. Farm size, number of farm workers, air quality, average pig mortality, and presence of pigs with undocked tails on the farm had no significant effect on AMU, whereas higher welfare standards were significantly associated with lower AMU.Abstract: The analysis of antimicrobial use (AMU) data in livestock allows for the identification of risk factors for AMU, thereby favoring the application of responsible AMU policies on-farm. Herewith, AMU in 36 finishing pig farms in northern Italy from 2015-2017 was expressed as defined daily doses for Italian pigs (DDDita) per population correction unit (DDDita/100kg). A retrospective analysis was then conducted to determine the effects of several husbandry practices on AMU. Overall, AMU ranged between 12 DDDita/100kg in 2015 and 8 DDDita/100kg in 2017, showing no significant trends, due to the large variability in AMU between farms. However, a 66% AMU reduction was observed in 19 farms during 2015-2017. Farm size, number of farm workers, air quality, average pig mortality, and presence of undocked pigs on the farm had no significant effects on AMU. Rather, welfare-friendly farms had 38% lower AMU levels (p < 0.05). In conclusion, animal welfare management seems to be relatively more important than farm structure and other managerial characteristics as drivers of AMU in finishing pig farms.