Public Hospital Pharmacists' Perceptions and Knowledge of Antibiotic Use and Resistance: A Multicenter Survey.

Phin Phin Lim,Sunitha Ganesan,Yen Ching Choong,Kai Lun Tang,Amer Hayat Khan,Sook Yee Ong,Tsyr Fen Teoh,Theng Theng Ooi,Long Chiau Ming,Sarah Abdul Karim,Sherene Su Ann Tan,Wei Ping Khor,Pao Pao Ch’Ng,Weng Siang Foong

doi:10.3390/antibiotics9060311

Abstract

Antimicrobial Stewardship Program (ASP) has been implemented in major public hospitals in Malaysia, with pharmacists playing a key role in ensuring the appropriate use of antibiotics. This survey aimed to assess the practices, perceptions, and knowledge of public hospital pharmacists on antibiotic use and resistance. A cross-sectional survey involving pharmacists from six public hospitals in Penang was conducted using a self-administered validated questionnaire. The majority of pharmacists perceived that polypharmacy (92%, n = 270) and overuse of broad-spectrum antibiotics (85%, n = 252) can potentially induce resistance of microorganisms and that ensuring the rational use of antibiotics is a shared responsibility between clinicians and pharmacists (94%, n = 278). A large majority of the pharmacists think that formal training in infectious disease should be a pre-requisite for pharmacists in ASP (93%, n = 273). In terms of antibiotic selection, the availability of antibiotics in hospital (81%, n = 234) and patient’s clinical condition (68%, n = 196) are more of a concern to the pharmacists. A total of 65% of the respondents (n = 192) demonstrated good levels of knowledge with a mean knowledge score of 10.1 out of 13 (95% CI: 9.95; 10.31). Pharmacists from the managerial level, ward pharmacy, in-patient, and medication therapy adherence clinic (MTAC) unit had better knowledge of antibiotics compared to pharmacists from other units (p < 0.001). Antibiotic knowledge gap had been identified among pharmacists in different work settings, and longer years of service does not warrant good antibiotic knowledge.

Highlights

The increased usage of antibiotics and inappropriate prescribing have exerted a selective pressure on clinically relevant bacteria, leading to the development of antimicrobial resistance (AMR)
The study respondents consisted of pharmacists from different pharmacy units, which included outpatient pharmacy, inpatient pharmacy, ward pharmacy, logistic, medication therapy adherence clinic (MTAC), Pharmacy Resources and Information Center (PRIC), management, and specialized units, i.e., therapeutic drug monitoring (TDM), clinical nutrition services, cytotoxic drug reconstitution (CDR), and pharmaceutical compounding/manufacturing
In term of involvement in antibiotic dispensing, the majority (93%) claimed that they performed antibiotic dispensing in the hospital whereby on average per week, 36% of these pharmacists estimated encountering more than 20 prescriptions containing antibiotics, 35% estimated handling 10–20 prescriptions with antibiotics, and 29% estimated handling less than 10 prescriptions with antibiotics

Summary

Introduction

The increased usage of antibiotics and inappropriate prescribing have exerted a selective pressure on clinically relevant bacteria, leading to the development of antimicrobial resistance (AMR). The AMR rate in Malaysia is reported to be on an increasing trend [1,2]. It will render the first-line antimicrobial ineffective, which leads to an overuse of second or third-line antimicrobials. Malaysia has started to implement policy and strategies to curb AMR in the public hospitals since early 2000s. The adaptation of the Malaysian National Antibiotic Guideline since 2008, with the implementation of the Antimicrobial Stewardship Program (ASP) in 2014 have augured well for the local AMR situation. Following the implementation of ASP, it has been demonstrated that there was an overall

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