Antimicrobial principles in the diagnosis and therapy of canine pyoderma: A review

BackgroundIrrational use of antimicrobials is highly prevalent. It is a major driving factor for antimicrobial resistance (AMR). Research on irrational antimicrobial use is important for developing policies and regulations to combat and contain AMR. The present study aims to provide an overview of research publications on the irrational use of antimicrobials at the national and global levels.MethodsPublications on irrational use of antimicrobials were extracted from Scopus using a wide range of relevant keywords for the study period from 1980 to 2020.ResultsIn total, 656 publications on irrational use of antimicrobials were found. The bulk of publications in this field were about irrational use in humans. A limited number of publications were found on the irrational use of antimicrobials in the context of veterinary and environment. The number of publications, contributing countries, and the mean number of authors per article increased with time, most notably in the last decade. Authors from 105 different countries participated in publishing the retrieved articles with 22 (21.0%) participated in 10 or more publications. The United States led with 140 (21.6%) articles followed distantly by China (n = 49, 7.5%), India (n = 45, 6.9%), and the United Kingdom (n = 45, 6.9%). Countries in the South-East Asian region (n = 69, 10.5%) and the African region (n = 42, 6.4%) made the least contribution. The list of most frequent author keywords included “antimicrobial stewardship” and “community pharmacies”. The research themes focused on the hospital-based rational use of antimicrobials and the self-medication practices with antimicrobials in the community. In total, 420 different journals participated in publishing the retrieved documents. The Plos One journal (17, 2.6%) ranked first. The retrieved articles received an average of 15.6 citations per article and an h-index of 52. The most frequent antimicrobials encountered in the retrieved literature were penicillin, cephalosporin, and fluoroquinolones while the most frequently encountered pathogens were S. aureus and P. aeruginosa.ConclusionResearch on the irrational use of antimicrobials is needed from all countries and regions to implement appropriate policies to contain the AMR. Research on irrational use of antimicrobials in the context of veterinary is needed.

The development of antimicrobial resistance (AMR) due to over or misuse of antibiotics/antimicrobials is a globally increasing public health concern. This study was conducted to assess the current knowledge, attitudes, and practices (KAP) of swine and poultry producers on antimicrobial use (AMU) and antimicrobial resistance (AMR). A total of 254 swine and poultry producers of 5 provinces in Cambodia were purposively surveyed using validated KAP questionnaires, a useful tool for promoting the rational use of antimicrobials in livestock. Collectively, this study found out that livestock producers in Cambodia have a low level of knowledge, neutral rather than positive attitudes, and employed poor practices on the AMU and AMR. Thus, there is a need to promote among producers the rational and responsible use of antimicrobials. Furthermore, public awareness of the AMR implications on public health can contribute to the prevention or reduction of AMU and AMR in Cambodia.

Background: Continuous monitoring of drug consumption is an important strategy for prudent and cost-effective use of drugs. Antimicrobials are among the most prescribed drugs in outpatient practice and in hospital care. In most cases antimicrobials are improperly prescribed or are even misused. Irrational use of antimicrobials is clinically ineffective and leads to higher treatment costs. Clinical ineffectiveness due to irrational use additionally leads to loss of confidence in antimicrobial drugs, unnecessary exposure of patients and development of antimicrobial resistance. Antimicrobial resistance has become a major global health problem as it presents an imperative for development of new potent antimicrobials which are necessarily associated with markedly higher treatment costs. Material and methods: This survey was focused on rational prescribing of antimicrobial drugs. The data on consumption of antimicrobials for various clinical departments of the Jesenice General Hospital were collected by the hospital pharmacy. WHO ATC 2005 classification system, which ranks antimicrobials in a large group J01: drugs for systemic treatment of bacterial infections and Defined Daily Dose as a measuring unit according to the WHO ATC/DDD methodology was used. Antimicrobial use at the Jesenice General Hospital in the period between 1998 and 2004 was estimated by the Department of Infectious Diseases, Medical Centre Ljubljana as a part of European Surveillance on Antibiotic Consumption project (ESAC). Statistical part of survey was performed by the Chair of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Ljubljana. Results: After year 2000 a trend of decrease in antimicrobial consumption was observed. Compared to European Surveillance on Antibiotic Consumption results in the year 2003 higher usage of penicillins with extended spectrum, fluoroquinolones and 3rd generation cephalosporins in Slovenian hospitals was estimated. These three groups of antimicrobials were also among the most frequently prescribed antimicrobials at the Jesenice General Hospital. However, the increase of their use during the observation period in our study was not significant. On the other hand significant decrease in consumption of cephalosporins was observed in correlation with increased consumption of aminoglycosides. According to the observed proportions of various antimicrobial groups in the total consumption of the ATC group J01 drugs, it can be concluded that their prescribing was appropriate for empirical treatment, especially since the use of second-line antimicrobials (glycopeptides, carbapenems and 4th generation cephalosporins) was low. Conclusions: At the Jesenice General Hospital combinations of penicillins with beta-lactamase inhibitors are still overused and should be replaced with the increased empirical prescribing of amoxicillin or ampicillin when possible. Additionally, de-escalation methodology of empirically prescribed wide spectrum antimicrobials according to antibiotic susceptibility results of isolated bacteria should be improved. 2nd generation instead of 3rd generation cephalosporins should be used preferentially whenever possible, especially in cases of switching to peroral antimicrobial treatment. In the future continuous participation in the European Surveillance on Antibiotic Consumption project should be assured and according to its results appropriate strategy of prudent antimicrobials use at the Jesenice General Hospital should be developed.

Hajj pilgrimage is a large mass gathering global event that may facilitate the spread and emergence of various infectious diseases as well as antimicrobial resistance (AMR) in a local and global scenario. Planning and preparing for these public health issues is a challenging and complex process for the Kingdom of Saudi Arabia (KSA) health authorities. Despite multiple efforts for the prevention and treatment of infectious diseases through longtime funding in education and medical care, the prevalence of infectious disease is still high among Hajj pilgrims. The commonly observed infectious diseases during Hajj include respiratory tract infections (influenza and pneumonia), urinary tract infections and skin infections that may necessitate the use of antimicrobials. Beta-lactams are used as a first-line treatment for hospital acquired infections as well as community acquired infections due to their broad-spectrum activity. However, most of the bacterial isolates such as Staphylococcus spp., Pseudomonas spp. and E. coli are resistant to beta-lactams. Irrational use of antimicrobials, lack of infection prevention practices and suboptimal healthcare access further exacerbate the risk of spreading AMR among Hajj pilgrims. Enhanced collaboration between countries, sharing of best practices and international cooperation are crucial in addressing AMR threats among pilgrims. Consequently, robust surveillance systems for early detection and monitoring of AMR, collaboration with national as well as international healthcare agencies, effective infection prevention and control measures, public awareness and rational use of antimicrobials via antimicrobial stewardship programs are required to mitigate the risk of AMR and ensure the health and well-being of pilgrims during Hajj.

Some microorganisms termed normal flora, are necessary for human life, whereas others are pathogenic and thus harmful to humans; as a result of contamination, these microbes cause infections that can lead to infectious diseases1–4. Infections that were once fatal can now be cured, and the use of antimicrobial agents has advanced global health; however, antimicrobials are the most mishandled of all drugs, which reduces their effectiveness in treatment4,5. Antimicrobial resistance (AMR) has become a significant threat to global public health and medical development, including the health system of the Democratic Republic of Congo (DR Congo). The DR Congo lacks comprehensive data on AMR, with limited surveillance on bacteria for example, Salmonella spp. and Staphylococcus aureus, whereas prospects for other bacteria remain unknown1,2. Amidst economic crises, conflicts, and many irregularities ongoing in Democratic Republic of Congo (DRC), AMR keeps increasing day by day and posing more public health challenges to the Congolese population. AMR remains a real challenge in resource-limited countries, for example, DR Congo because of a lack of available antibiotics, with multidrug-resistant (MDR) isolates being labeled on the basis of a small number of antibiotics tested. This has economic consequences and yet the use of the old molecules is very effective. The consequences of AMR are not limited to patients with infections but to a whole system including the environmental and agropastoral sectors that encompass enough resistance genes6. In the coming years, microbes may become resistant to many more spectrums of antibiotics. For example, several studies have shown that there is AMR to date, mainly to β-lactam antibiotics, Cephalosporins, Carbapenems, Colistin, and Tigecycline in DR Congo2,4,7. Researchers found that bacterial resistance to antibiotics concerned both gram-negative and gram-positive bacteria; MDR prevalence was the same in half of Streptococcus pneumoniae isolates; a worrying prevalence of methicillin-resistant S. aureus was noted, which is associated with coresistance to several other antibiotics; and resistance to third-generation cephalosporins was very high in Enterobacteriaceae, mainly because of blaCTX-M-1 group and blaSHV genes5–9. Data on carbapenem and colistin resistance were not available in DR Congo until recently. Salmonella spp. is the most studied bacterial genus in DR Congo as a result of the research set up and is still ongoing since 2008 on bacteremia. Indeed, since the first publications on bacteremia, the prevalence of resistance to ampicillin, chloramphenicol, and cotrimoxazole popularly called sceptrin is particularly high (90%–100%)10–12. Further work is required to set up a surveillance system for antibiotic resistance in DRC. Also, AMR, being a major global threat, has increased health care costs and poor health-seeking behaviors among the Congolese5. The World Health Organization recommends a minimum of $35 per capita to safeguard a country’s population. But unfortunately, out of the 424 hospitals in DR Congo, very few have organized a microbiology service because of a lack of electricity, infrastructure, and specially qualified personnel, as the only university in DR Congo that trains them markets 2–4 clinical microbiologists per year4. This serious threat of AMR in DR Congo is the ineffectiveness of the antibacterial molecules available in the market, which means that the use of old molecules, which prove to be more active with MDR isolates elsewhere should quickly orient the regulatory authorities to change procurement policies5. AMR also poses the risk that some treatable and curable diseases or minor infections, for example, cellulitis, meningitis, tuberculosis, etc could become incurable. This could further impose a greater economic burden on vulnerable families and DR Congo’s health care system, resulting in increased suffering, morbidities, and mortalities6. There are many other contributing factors to AMR in DR Congo, including uncontrolled and irrational antimicrobial use, the availability of dubious or poor-quality antimicrobial products, the sale of antimicrobials without a proper medical prescription, a lack of control over pharmaceutical regulations, and noncompliance with prescribed drugs or a lack of supply of these drugs due to unaffordable prices among the Congolese population4. Infectious diseases are currently the leading cause of death in our health care systems, and antibiotics alleviate these burdens, saving millions of lives. The failure to treat infections is the primary consequence of AMR, and this therapeutic failure leads to an increase in the number of deaths. To combat AMR in DR Congo, it is crucial to establish a national surveillance system for antimicrobial consumption and AMR. The Congolese government should make a drastic improvement in the AMR research implementation policy to eliminate unnecessary antibiotic dispensations among medical personnel and citizens while promoting antibiotic dispensations through medical prescriptions7. Antibiotic prescriptions should be based on clinical data or arguments, which is made possible by effective, rapid, and low-cost diagnostic tools. This is important for the optimal and rational use of antimicrobials in DR Congo. In DR Congo, there are several uncontrolled reasons, especially for socioeconomic reasons for the use of antibiotics in the community. To make matters worse, many antimicrobial prescribers and sellers in the country are not well-trained pharmaceutical professionals, resulting in inappropriate therapeutic regimens. In this case, we recommend that the health system and the Ministry of Public Health of DR Congo strengthen antimicrobial consumption regulation, as well as adequate sensitization of data providers on the importance of surveillance, antimicrobial coadministration, and antimicrobial coadministration4,6. Also, there should be an improved collaboration between the national pharmaceutical regulatory authority and the general directorate of customs to ensure the traceability of drug imports, particularly antimicrobials, and to encourage local antimicrobial production by pharmaceutical industries established in DR Congo. Most importantly, there should be strict monitoring of antimicrobial use in health care facilities and the establishment of a quality assurance system for data collection and processing. As AMR continues to be a major threat to DR Congo’s already destabilized and fragile health system, we believe that this critical and neglected issue needs to be addressed critically. Hence, the health authorities of the DRC need to consider the negative effects of AMR in the future and devise well-implemented strategies, especially in areas of antimicrobial research implementation and through the One Health approach to mitigate these consequences. Some of these implementations and the One Health approach include the involvement of the religious and traditional leaders including the market women in DRC. These people should be trained in AMR. Conversely, they could pass the training across to other citizens during religious worship, cultural events, market forums, etc. Also, there is an urgent need to create collaborative and partnership networks with all microbiology laboratories across the country, as well as the international communities who are experts in AMR, which will then be linked to external laboratories to effectively address the AMR problem5. If all these recommendations are put in place in the DRC, there should be a positive outcome and a high yield against AMR in the country, which would put a smile on the face of the citizens and the government Ethical approval None. Sources of funding None. Author contributions Conceptualization; M.O.O. and A.A. Manuscript preparation; A.A. Project administration; A.A.. Funding acquisition; A.A. Writing of initial draft; All authors, except M.O.O. Writing; review and comments; M.O.O. and B.J. Supervision; M.O.O. Final approval of manuscript for publication; All authors. Conflict of interest disclosures The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) Not applicable. Guarantor Malik Olatunde Oduoye.

BackgroundThere are concerns with the extent of dispensing of antibiotics among community pharmacists in Pakistan often without a prescription adding to antimicrobial resistance (AMR) rates.ObjectiveTo explore the determinants of AMR...

The procedure for manufacture, sale and rational use of antimicrobial veterinary medicinal products in veterinary medicine must comply with the national legislation, namely the Law of Ukraine “On Veterinary Medicine”. Only authorized in Ukraine veterinary medicinal products have been used in veterinary medicine as required with the recommendations stated in package leaflet, labeling and summary of the product characteristic. The article describes main principles of monitoring process sales turnover of antimicrobial veterinary medicinal products during period of study 2015-2018.
 On the suggestion of the World Organization for Animal Health (OIE) at the beginning of 2016 Ukraine started collecting annual sales data (for the previous year) on antimicrobial veterinary medicinal products in food-producing and domestic animals in accordance with the Chapter 6.9. of the Terrestrial Animal Health Code, 2016; 2018.
 The main goal of this study was the implementation of OIE recommendations in monitoring process by the assessment of sales patterns of antimicrobials, their influence on prudent use, in compliance with Ukrainian National Action Plan Tackling Antimicrobial Resistance, 2019. The study was conducted during four 12-month periods (from January 1 to December 31) during 2015-2018. The data in questionnaires reports were received from marketing authorization holders and distributors and collected as suggested by OIE. The specification of the amounts of the antimicrobials annual sales during 2015-2018 according route of administration and antimicrobial classes in [kg] and [%] of active ingredient were presented.
 The study revealed the main high-selling classes of antimicrobials (Tetracyclines, Penicillins and Sulfonamide+Trimethoprim); the commonly used route of administration (oral ~ 90 %) and part of veterinary critically important and important antimicrobials in total sales amounts of all antimicrobial veterinary medicinal products. Macrolides occupied the main part (10,2 %) in veterinary critically important antimicrobial medicinal products; part of Aminoglycosides was ~ 4 %; Fluoroquinolones – among 2,5 - 7,14 % and part of Cephalosporins was less than 1% during all years of the study.
 This study can be considered as the first step towards implementation a national monitoring system for rational and prudent use of antimicrobials in veterinary medicine.

Background: Antimicrobials are routinely prescribed in several disease conditions in which infections are established or suspected to be the reason for the illness. Excessive and irrational use of antimicrobials leads to development of drug resistance in microorganisms, besides increasing health-care expenditure. Antimicrobial resistance (AMR) leads to increase in morbidity and mortality. The rational use of antimicrobials is a major health need in all countries. Hence, assessment of prescribing pattern of antimicrobials is essential for clinical, educational, and economic purposes. Aims and Objectives: The objectives of the study were to evaluate and compare the prescribing pattern of antimicrobials by assessing – (i) commonly used antimicrobials; and (ii) disease conditions for which they were prescribed. Materials and Methods: It was a prospective observational study done for a period of 1 month. All the prescriptions in which antimicrobials were prescribed in the outpatient departments (OPD) and in-patient wards (IP) were included in the study. Prescriptions were analyzed for demographic and antibiotic data. Results: 1092 prescriptions were collected and analyzed. Among them, 690 prescriptions were from OPD and 382 prescriptions from in patient wards. Out patient data: Cefixime (21.30%) was commonly prescribed followed by fixed dose combination of Amoxicillin + Clavulanic acid (14.64%) and Ciprofloxacin (8.84%). Cefixime was commonly prescribed for URTI (13.43%). Oral route (82.17%) was the preferred route of administration. IP data: Cefotaxime (26.45%) was commonly prescribed followed by fixed dose combination of Piperacillin + Tazobactum (15.29%) and Ceftriaxone (14.46%). Cefotaxime was commonly prescribed preoperatively for most of the surgeries (76.56%). Intravenous route (46.86%) was the preferred route of administration. Single antimicrobial therapy (81.41%) was preferred followed by double (17.80%) and triple (0.79%) antimicrobial therapy. Conclusion: Cefixime and cefotaxime were commonly used in OPD and in patient wards, respectively. Oral route and intravenous route were the preferred route in OPD and IP wards, respectively. Single antimicrobial therapy was commonly preferred in both IP and out-patient wards. Although double and triple antimicrobial therapy was prescribed in small number of patients, it should be cautiously used to prevent AMR.

The threat of antimicrobial resistance (AMR) in Malawi is high with reported mortality of 19,300 annually, the 23rd highest age-standardised mortality. One of the drivers of AMR is misuse of antibiotics, a phenomenon that has not been adequately researched in Malawi. This study aims to investigate antimicrobial use using health facility, prescribing and patient indicators in Christian Health Association of Malawi (CHAM) health facilities. This will be a multiple cross-sectional study, which will collect data from facilities (22), prescriptions (660), and patients (303). Data will be collected using KoboToolbox v2021, and exported into Microsoft Excel version 2016 for cleaning and coding. Variables will be categorised according to the antimicrobial use indicators. The study will use STATA Version 14 statistical software for data analysis. Subsequently, facilities will be entered into ArcGIS Version 10.7.1 to map hotspots of irrational antimicrobial use. The study will run from October 2024 to June 2025. This study will provide detailed information on frequently used antimicrobials, the cost of antimicrobials relative to medicine budget, the intensity of exposure to antimicrobials, the availability of antimicrobials, patients’ understanding of antimicrobials use, and availability of important documents for antimicrobial use. Secondarily, the study will unravel the prevalence of irrational antimicrobial use, the main factors contributing to it, and location where irrational use is most prevalent. These findings will inform the national antimicrobial stewardship action plan, aiming to safeguard the available antimicrobials.

The threat of antimicrobial resistance (AMR) in Malawi is high with reported mortality of 19,300 annually, the 23rd highest age-standardised mortality. One of the drivers of AMR is misuse of antibiotics, a phenomenon that has not been adequately researched in Malawi. This study aims to investigate antimicrobial use using health facility, prescribing and patient indicators in Christian Health Association of Malawi (CHAM) health facilities. This will be a multiple cross-sectional study, which will collect data from facilities (22), prescriptions (660), and patients (303). Data will be collected using KoboToolbox v2021, and exported into Microsoft Excel version 2016 for cleaning and coding. Variables will be categorised according to the antimicrobial use indicators. The study will use STATA Version 14 statistical software for data analysis. Subsequently, facilities will be entered into ArcGIS Version 10.7.1 to map hotspots of irrational antimicrobial use. The study will run from October 2024 to June 2025. This study will provide detailed information on frequently used antimicrobials, the cost of antimicrobials relative to medicine budget, the intensity of exposure to antimicrobials, the availability of antimicrobials, patients' understanding of antimicrobials use, and availability of important documents for antimicrobial use. Secondarily, the study will unravel the prevalence of irrational antimicrobial use, the main factors contributing to it, and location where irrational use is most prevalent. These findings will inform the national antimicrobial stewardship action plan, aiming to safeguard the available antimicrobials.

Veterinary drugs are used as therapeutic, prophylactic and growth promotion. The review was conducted with the aim of assessing the rational use of veterinary antimicrobials. Veterinary drugs are used in livestock sector either rationally or irrationally. Rational use of veterinary drugs means sick animals receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period, and at the lowest cost. Whereas irrational drug use are characterized by over prescription, omission, the use of inappropriate dosage, incorrect duration, misuse of drug, take unnecessary risk, over use /frequent use of drugs and not stick with withdrawal period of a drug. The review indicates veterinary drugs used irrationally due to lack of knowledgeable of healthcare providers, lack of treatment guidelines, essential drug lists and national formularies, lack of diagnostic support services such as laboratory services, self-medication and purchasing of antibiotics directly from pharmacies, street vendors or markets and inadequate supply of veterinary drugs. Irrational use of drugs leads to antimicrobial resistance which is the current global health threat to animals and human being. Hence, veterinary drugs, especially, antimicrobial agents should be prudently used, improve availability of key essential drugs on stock through good drug supply management to reduce misuse of drugs and therapeutic failure, keep the withdrawal period to safeguard the public as well the livestock from drug residual effects and development of antimicrobial resistance are recommended.

This chapter contains sections titled: Introduction Antimicrobial use in animals History of prudent antimicrobial use Prudent and rational antimicrobial use: global approach and basic principles The need to shift from general principles to practice guidelines References

The practice of medicine has been transformed by antimicrobials. However, overuse and misuse of anti-microbials is one of the major global health problems. Longer and expensive hospital stays are expected for those patients who are suffering from multi-drug resistant organisms.1 Antibiotic stewardship is an emerging concept and may be defined as coordinated interventions to imp-rove and measure the appropriate use of antimicrobials with selection of the optimal antimicrobial drug regimen, duration, dose, and route of administration.” Antibiotic stewardship program (ASP) is aimed to tar-get the antibiotic related optimal clinical outcomes, minimal toxicity and adverse events, cost reduction for infections, and curtail the selection for antimicrobial resistant strains.Centre for disease control and prevention (CDC) has described core elements of hospital ASP, the essentials of these are leadership commitment, accountability, drug expertise, action, tracking, reporting, and education.2 This program has larger impact on infection rates, resistance patterns, costs and clinical outcomes in many studies.3, 4 Pakistan, being the developing country, is facing the problem of antimicrobial resistance at large due to irrational use of antimicrobials. Review of data on drug use in Pakistan shows the excessive and irrational drug use in Pakistan with higher use of antimicrobials and injections and choice of more expensive drugs with inadequate dispensing, compared to the lower middle income countries. The injudicious use of anti-microbials attribute towards antimicrobial resistance and emergence of new mutant strain.5-8 In Pakistan, there is need to conduct drug utilization to identify appropriate usage of drugs in terms of medical, social and economic aspects. To overcome the problem, strategies to decrease unnecessary anti-biotic prescription like “Antibiotic Stewardship Programs” must be implemented.9 In Pakistan, Medical microbiology and Infectious diseases society of Pakis-tan (MMIDSP) has taken initiative to develop indigenous ASP and training program. The ASP should be the part of undergraduate curriculum to sensitize our future doctors. The regulatory authorities should also be active in monitoring the judicious use of antimicrobials. The masses should have easy access to the quality health care services, so as to minimize the irrational antimicrobial use.

ABSTRACTIntroduction: In recent years the development of antimicrobial resistance has been accelerating, the discovery of new antimicrobial agents has slowed substantially in past decades.Area covered: This review mainly focuses on the problem of antimicrobial resistance(AMR); the various contributor mechanisms, consequences and future of AMR. The review also highlights the irrational use of antimicrobials, improving their usage and problems associated with pharmacovigilance of antimicrobial resistance.Expert opinion: Pharmacovigilance in the form of surveillance of antibiotic use is being done in 90% of the countries worldwide through the WHONET program developed by WHO. However, the data comes from a limited area of the globe. Data from every part of the world is required, so that there is geographical representation of every region. A major hurdle in quantifying the extent of antimicrobial resistance is the fact that there are several known microbes, that may turn out to be resistant to one or more of the several known antimicrobial agents. The global action plan initiated by WHO, if implemented successfully will definitely reduce AMR and will help in evaluating treatment interventions.

BackgroundAntimicrobial misuse and overuse propagate antimicrobial resistance, yet data on factors influencing antibiotic prescription decisions in low-resource settings are limited. We describe factors influencing antimicrobial prescription at a large tertiary care private not-for-profit hospital in Uganda.MethodsWe conducted a descriptive phenomenology qualitative study involving face-to-face in-depth interviews of 12 purposively selected prescribers (four intern doctors, six medical officers and two Internal Medicine physicians) in a private not-for-profit hospital in Kampala, Uganda. Audio recordings and filed notes were transcribed verbatim and analysed manually by content analysis. Emerging themes and sub-themes were recorded and reported.ResultsThree broad themes emerged: experience with antimicrobial use in Uganda, barriers and facilitators to rational antimicrobial prescription and measures to address irrational antimicrobial use. Participants recognized that antibiotics are often used irrationally, prescribed even when there is uncertainty regarding clinical evidence for infection, and influenced by drug promoters, and noted high levels of antibiotic resistance. Patients’ symptoms and clinical signs, previous experience using antibiotics, fear of bad outcomes, patient demand and expectations, influence from senior colleagues, the turnaround time of clinical investigations and drug marketers were the barriers and facilitators to antimicrobial prescription. Prescribers also acknowledged the need to update clinical guidelines, set up hospital antibiograms, and provide continuous medical education on rational antimicrobial use.ConclusionsA complex interplay of intrinsic and extrinsic factors influences antibiotic prescribing decisions in this hospital. Targeted interventions through continuous education and training for prescribers, providing local prescription guidelines and antibiograms and implementing regulations on over-the-counter antibiotic sales are needed to implement robust antimicrobial stewardship programmes to curb antimicrobial resistance successfully.