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“If it’s a broad spectrum, it can shoot better”: inappropriate antibiotic prescribing in Cambodia
BACKGROUND: 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 interviewed physicians working in public hospitals to explore the drivers of inappropriate antibiotic prescribin...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5170903/ https://www.ncbi.nlm.nih.gov/pubmed/28031814 http://dx.doi.org/10.1186/s13756-016-0159-7 |
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author | Om, Chhorvoin Daily, Frances Vlieghe, Erika McLaughlin, James C. McLaws, Mary-Louise |
author_facet | Om, Chhorvoin Daily, Frances Vlieghe, Erika McLaughlin, James C. McLaws, Mary-Louise |
author_sort | Om, Chhorvoin |
collection | PubMed |
description | BACKGROUND: 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 interviewed physicians working in public hospitals to explore the drivers of inappropriate antibiotic prescribing. METHODS: Hospitals 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. RESULTS: Inappropriate 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. CONCLUSIONS: The 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. |
format | Online Article Text |
id | pubmed-5170903 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-51709032016-12-28 “If it’s a broad spectrum, it can shoot better”: inappropriate antibiotic prescribing in Cambodia Om, Chhorvoin Daily, Frances Vlieghe, Erika McLaughlin, James C. McLaws, Mary-Louise Antimicrob Resist Infect Control Research BACKGROUND: 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 interviewed physicians working in public hospitals to explore the drivers of inappropriate antibiotic prescribing. METHODS: Hospitals 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. RESULTS: Inappropriate 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. CONCLUSIONS: The 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. BioMed Central 2016-12-20 /pmc/articles/PMC5170903/ /pubmed/28031814 http://dx.doi.org/10.1186/s13756-016-0159-7 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Om, Chhorvoin Daily, Frances Vlieghe, Erika McLaughlin, James C. McLaws, Mary-Louise “If it’s a broad spectrum, it can shoot better”: inappropriate antibiotic prescribing in Cambodia |
title | “If it’s a broad spectrum, it can shoot better”: inappropriate antibiotic prescribing in Cambodia |
title_full | “If it’s a broad spectrum, it can shoot better”: inappropriate antibiotic prescribing in Cambodia |
title_fullStr | “If it’s a broad spectrum, it can shoot better”: inappropriate antibiotic prescribing in Cambodia |
title_full_unstemmed | “If it’s a broad spectrum, it can shoot better”: inappropriate antibiotic prescribing in Cambodia |
title_short | “If it’s a broad spectrum, it can shoot better”: inappropriate antibiotic prescribing in Cambodia |
title_sort | “if it’s a broad spectrum, it can shoot better”: inappropriate antibiotic prescribing in cambodia |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5170903/ https://www.ncbi.nlm.nih.gov/pubmed/28031814 http://dx.doi.org/10.1186/s13756-016-0159-7 |
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