Exploring Physicians' Views, Perceptions and Experiences about Broad-Spectrum Antimicrobial Prescribing in a Tertiary Care Hospital Riyadh, Saudi Arabia: A Qualitative Approach.

Nada A Alsaleh,Hussain A Al-Omar,Alexander B Mullen,Ahmed Y Mayet

doi:10.3390/antibiotics10040366

Abstract

Antimicrobial resistance (AMR) is a global public health threat associated with increased mortality, morbidity and costs. Inappropriate antimicrobial prescribing, particularly of broad-spectrums antimicrobials (BSAs), is considered a major factor behind growing AMR. The aim of this study was to explore physician perception and views about BSAs and factors that impact upon their BSAs prescribing decisions. Qualitative semistructured telephone interviews over an eleven-week period were conducted with physicians in a single tertiary care hospital in Riyadh, Saudi Arabia. Purposeful and snowball sampling techniques were adopted as sampling strategy. All interviews were audio recorded, transcribed verbatim, uploaded to NVivo® software and analysed following thematic analysis approach. Four major themes emerged: views on BSAs, factors influencing BSA prescribing and antimicrobial stewardship: practices and barriers and recommendations to improve appropriate BSA prescribing. Recommendations for the future include improving clinical knowledge, feedback on prescribing, multidisciplinary team decision-making and local guideline implementation. Identification of views and determinants of BSA prescribing can guide the design of a multifaceted intervention to support physicians and policymakers to improve antimicrobial prescribing practices.

Highlights

Antimicrobial resistance (AMR) is a global public health threat associated with increased mortality, morbidity and costs [1]
Physicians are supportive of antimicrobial stewardships programmes (AMS) [9]; one of the challenges and barriers to AMS is the lack of physician consensus on what is considered an appropriate choice when deciding to initiate prescribing of a broad-spectrums antimicrobials (BSAs) [10]
The extent to which the physicians are oriented about AMR and the impact of inappropriate prescribing on wider society may be considered as a reason that led to the underestimation of the negative consequences of inappropriate antimicrobial prescribing

Summary

Introduction

Antimicrobial resistance (AMR) is a global public health threat associated with increased mortality, morbidity and costs [1]. Implementing antimicrobial stewardships programmes (AMS) aimed to enhance the appropriate prescribing of antimicrobials may lower inappropriate or overuse of BSAs [3,4]. The World Health Organization has recognised the potential of these programmes through endorsement of the antimicrobial stewardship policy and strategy as part of the global action plan to decrease AMR risk. [6] implementation of AMS in a hospital setting has been endorsed by several countries and institutions to improve the appropriate use of antimicrobials, decreasing AMR [7,8]. To implement successful interventions to improve the appropriateness of BSA prescribing, it is essential to investigate and recognise physicians’ perceptions and views about BSAs and identify how they decided on antimicrobial prescribing [15]

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