Abstract
Considering that antimicrobial resistance (AMR) is a global challenge, there is a dire need to assess the knowledge, attitude, and practice (KAP) of clinicians in AMR endemic countries. The current multicenter, cross-sectional study aimed at highlighting gaps in antimicrobial (AM) stewardship and AMR among practicing doctors working in public tertiary care teaching hospitals of Lahore, Pakistan. A KAP survey, based on a self-administered questionnaire containing 45 questions, was distributed among 336 clinicians in 6 randomly selected hospitals. Overall, 92% of the clinicians considered AMR as a worldwide problem but only 66% disagreed that cold and flu symptoms require antibiotics. Moreover, around 68% of the doctors felt confident about their practice in AM but still, 96% felt the need to get more knowledge about AM drugs. The need for refresher courses on rational antibiotic use was expressed by 84% of the participants. The main contributing factors considered for AMR by the doctors included excessive AM usage in the medical profession (87.1%) and multiple antibiotics per prescription (76.4%). Pharmacologically, AM spectrum was accurately chosen by 1.4% for Ampicillin, 0.003% for Erythromycin and 0% for Levofloxacin. Clinically, more than 50% of the clinicians used miscellaneous AM for empirical therapy of respiratory tract infection and cholecystitis. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. It is concluded that the knowledge of clinicians is relatively poor for AM spectrum and drugs of choice for certain infections. However, the clinicians are aware of their shortcomings and desire for improvement.
Highlights
There were significant advances in antimicrobial therapy in the 1980s as the third-generation cephalosporin and new fluoroquinolones proved to be highly effective, the widespread usage of these newly developed drugs soon gave rise to a new problem
It is known that misuse of antibiotics by the general population increases the chance of getting infected with resistant strains of bacteria, yielding higher morbidity and mortality (Costelloe et al 2010; Woodford and Livermore 2009)
The best approach to control the spread of antimicrobial resistance (AMR) is to minimize antimicrobial usage and it can be achieved by changes in prescribing behaviors (García et al 2011; Giblin et al 2004; Guerra et al 2007; Pulcini et al 2011; Srinivasan et al 2004; Wester et al 2002)
Summary
There were significant advances in antimicrobial therapy in the 1980s as the third-generation cephalosporin and new fluoroquinolones proved to be highly effective, the widespread usage of these newly developed drugs soon gave rise to a new problem. Factors responsible for AMR in third-world countries include over-prescription, unnecessary prescribing, incomplete treatment courses, self-medication, as well as insufficient infection control measures to prevent the spread of resistant bacteria in the community and hospitals (Okeke 2010; Sosa et al 2010). The best approach to control the spread of AMR is to minimize antimicrobial usage and it can be achieved by changes in prescribing behaviors (García et al 2011; Giblin et al 2004; Guerra et al 2007; Pulcini et al 2011; Srinivasan et al 2004; Wester et al 2002). The questionnaire was submitted in a pilot test to 34 participants to check comprehension and clarity of the questions
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