Antibiotics | Barriers and Enablers to Optimal Antimicrobial Use in Respiratory Tract Infections

This study provides in-depth insights into the knowledge, barriers, and enablers related to antimicrobial prescribing guidelines for respiratory tract infections, through semi-structured interviews with antimicrobial stewardship pharmacists and respiratory and infectious disease specialists, offering new perspectives for optimizing antimicrobial use.

 

Literature Overview
The article titled 'Barriers and Enablers to Optimal Antimicrobial Use in Respiratory Tract Infections', published in the journal Antibiotics, reviews and summarizes the use of antimicrobial prescribing guidelines, perceptions of adherence, and factors influencing optimal antimicrobial use within hospitals in New South Wales, Australia. Using qualitative interviews, the study collected data from 17 healthcare professionals (10 antimicrobial stewardship pharmacists, 5 respiratory specialists, and 2 infectious disease experts) to analyze resources relied upon in prescribing decisions, guideline evaluations, variations in adherence, and specific barriers and enablers. The research reveals cognitive discrepancies and systemic limitations in antimicrobial prescribing behaviors, providing a foundation for future antimicrobial stewardship interventions.

Background Knowledge
Respiratory tract infections (RTIs) are one of the primary indications for antimicrobial prescriptions. However, treatment often deviates from clinical guidelines, exacerbating the issue of antimicrobial resistance (AMR). Although various antimicrobial stewardship (AMS) interventions exist, such as electronic decision support, feedback mechanisms, and educational campaigns, significant discrepancies in antimicrobial use persist, especially in complex clinical scenarios. This study focuses on antimicrobial prescribing practices in hospital settings, highlighting disparities in antimicrobial resource access, expert support, and availability of rapid diagnostic tools, particularly in regional and private hospitals. Furthermore, the study emphasizes the influence of individual experience and prescribing habits on antimicrobial selection, and how stewardship efficiency can be enhanced through improved guideline accessibility, real-time feedback, and better diagnostic tools. These findings have significant implications for global AMR management and provide an empirical basis for the design of future prescribing interventions.

 

 

Research Methods and Experiments
The study employed semi-structured interviews to conduct in-depth discussions with 17 healthcare professionals from New South Wales, Australia, including 10 antimicrobial stewardship pharmacists, 5 respiratory specialists, and 2 infectious disease experts. The interviews focused on the use of antimicrobial prescribing resources, perceptions of guideline adherence, and the barriers and enablers influencing prescribing behaviors. After transcription and thematic coding, the data were categorized into five major themes: resource use, resource evaluation, guideline adherence, prescribing barriers, and enablers.

Key Conclusions and Perspectives

• Of the 17 participants, 16 primarily used the Australian Therapeutic Guidelines for antimicrobial prescribing as a decision-support tool, although some found the content overly lengthy or lacking coverage of rare pathogens.
• Significant discrepancies were observed between antimicrobial stewardship pharmacists and physicians regarding perceptions of guideline adherence. Pharmacists generally perceived prescribing adherence to be around 50%, whereas physicians self-reported higher adherence rates.
• Key barriers included insufficient diagnostic test sensitivity, limited resources in regional and private hospitals, patient-driven treatment pressures, inadequate awareness of antimicrobial resistance, and entrenched prescribing habits.
• Enablers to improved antimicrobial use included establishing strong working relationships with antimicrobial stewardship teams, providing timely prescribing feedback, increasing access to local resistance data and rapid diagnostic tools, and integrating decision-support tools into electronic prescribing systems.
• Regional hospitals often relied on empirical broad-spectrum antimicrobials due to the lack of on-site microbiological testing and imaging facilities, while private hospitals frequently extended antimicrobial duration due to less frequent physician rounds.

Research Significance and Prospects
This study provides new empirical evidence for antimicrobial stewardship interventions, emphasizing the need for future initiatives to focus on improving access to rapid diagnostic tools, enhancing communication between stewardship teams and clinicians, and refining prescribing feedback mechanisms. Additionally, the study recommends strengthening antimicrobial stewardship support in regional and private hospitals to improve the scientific rigor and rationality of antimicrobial use, thereby reducing the development of antimicrobial resistance.

 

 

Conclusion
This study highlights the current state of antimicrobial prescribing for respiratory tract infections in Australian hospitals, noting that, despite the availability of national guidelines, prescribing behaviors are influenced by multiple factors including physician experience, patient expectations, delayed diagnoses, and resource constraints. Antimicrobial stewardship pharmacists and specialists emphasize that optimizing antimicrobial use requires enhanced prescribing feedback, improved guideline accessibility, and better integration of local resistance data and rapid diagnostic tools. Future antimicrobial stewardship interventions should focus on addressing resource disparities in regional and private hospitals to improve prescribing practices and patient safety, and to effectively combat antimicrobial resistance.

 

Savannah Reali, Jin-Gun Cho, Jan-Willem Alffenaar, and Parisa Aslani. Barriers and Enablers to Optimal Antimicrobial Use in Respiratory Tract Infections. Antibiotics.