"If it's a broad spectrum, it can shoot better": inappropriate antibiotic prescribing in Cambodia.

Erika Vlieghe,Mary-Louise McLaws,Frances Daily,Chhorvoin Om,James C. McLaughlin

doi:10.1186/s13756-016-0159-7

Abstract

BackgroundCambodia is affected by antibiotic resistance but interventions to reduce the level of resistance require knowledge of the phenomena that lead to inappropriate prescribing. We interviewed physicians working in public hospitals to explore the drivers of inappropriate antibiotic prescribing.MethodsHospitals participating in a knowledge, attitudes and practices survey prior to this study were purposively selected and physicians were randomly recruited to participate in focus group discussions. Nvivo version 10 was used to inductively code the qualitative transcripts and manage thematic data analysis.ResultsInappropriate antibiotic prescribing was a common practice and driven by seven factors: prescribing habit, limited diagnostic capacity, lack of microbiology evidence, non-evidence-based clinical guidelines, perceived patient demand, poor hygiene and infection control, and perceived bacterial resistance to narrow spectrum antibiotics. “Every day, doctors are not performing appropriately. We have made lots of mistakes with our antibiotic prescribing.” When a patient’s clinical condition was not responsive to empiric treatment, physicians changed to a broader spectrum antibiotic and microbiology services were sought only after failure of a treatment with a broad-spectrum antibiotic. This habitual empirical prescribing was a common practice regardless of microbiology service accessibility. Poor hygiene and infection control practices were commonly described as reasons for ‘preventive’ prescribing with full course of antibiotics while perception of bacterial resistance to narrow-spectrum antibiotics due to unrestricted access in the community resulted in unnecessary prescribing of broad spectrum antibiotics in private practices.ConclusionsThe practice of prescribing antibiotics by Cambodian physicians is inappropriate and based on prescribing habit rather than microbiology evidence. Improvement in prescribing practice is unlikely to occur unless an education program for physicians focuses on the diagnostic capacity and usefulness of microbiology services. In parallel, hygiene and infection control in hospital must be improved, evidence-based antibiotic prescribing guidelines must be developed, and access to antibiotics in community must be restricted.

Highlights

Cambodia is affected by antibiotic resistance but interventions to reduce the level of resistance require knowledge of the phenomena that lead to inappropriate prescribing
We recently reported that over half of Cambodian physicians working in public hospitals surveyed nationally acknowledged that their antibiotic prescribing was inappropriate [16]
Our findings revealed that antibiotics prescribing occurred in the absence of microbiology evidence of infection

Summary

Introduction

Cambodia is affected by antibiotic resistance but interventions to reduce the level of resistance require knowledge of the phenomena that lead to inappropriate prescribing. Inappropriate antibiotic use is especially high in resource-poor countries and occurs in both healthcare and non-healthcare settings with physicians, patients and the general public accelerating the trend [5,6,7]. Like other resource-poor settings inappropriate antibiotic use [11, 12] and antibiotic resistance [13,14,15] in Cambodia are common place. We recently reported that over half of Cambodian physicians working in public hospitals surveyed nationally acknowledged that their antibiotic prescribing was inappropriate [16].

Methods

Discussion

Conclusion