Kizito Mark, Lalitha Rejani, Kajumbula Henry, Muhumuza Richard, Kintu Moses Grace, Muyanja David, Byakika-Kibwika Pauline
Department of Internal Medicine, School of Health Sciences, Soroti University Soroti, Uganda.
Department of Medicine, Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda.
JAC Antimicrob Resist. 2024 Dec 18;6(6):dlae204. doi: 10.1093/jacamr/dlae204. eCollection 2024 Dec.
Antimicrobial misuse and overuse propagate antimicrobial resistance, yet data on factors influencing antibiotic prescription decisions in low-resource settings are limited. We describe factors influencing antimicrobial prescription at a large tertiary care private not-for-profit hospital in Uganda.
We conducted a descriptive phenomenology qualitative study involving face-to-face in-depth interviews of 12 purposively selected prescribers (four intern doctors, six medical officers and two Internal Medicine physicians) in a private not-for-profit hospital in Kampala, Uganda. Audio recordings and filed notes were transcribed verbatim and analysed manually by content analysis. Emerging themes and sub-themes were recorded and reported.
Three broad themes emerged: experience with antimicrobial use in Uganda, barriers and facilitators to rational antimicrobial prescription and measures to address irrational antimicrobial use. Participants recognized that antibiotics are often used irrationally, prescribed even when there is uncertainty regarding clinical evidence for infection, and influenced by drug promoters, and noted high levels of antibiotic resistance. Patients' symptoms and clinical signs, previous experience using antibiotics, fear of bad outcomes, patient demand and expectations, influence from senior colleagues, the turnaround time of clinical investigations and drug marketers were the barriers and facilitators to antimicrobial prescription. Prescribers also acknowledged the need to update clinical guidelines, set up hospital antibiograms, and provide continuous medical education on rational antimicrobial use.
A complex interplay of intrinsic and extrinsic factors influences antibiotic prescribing decisions in this hospital. Targeted interventions through continuous education and training for prescribers, providing local prescription guidelines and antibiograms and implementing regulations on over-the-counter antibiotic sales are needed to implement robust antimicrobial stewardship programmes to curb antimicrobial resistance successfully.
抗菌药物的滥用和过度使用助长了抗菌药物耐药性，但关于影响资源匮乏地区抗生素处方决策因素的数据有限。我们描述了乌干达一家大型三级医疗私立非营利性医院中影响抗菌药物处方的因素。
我们开展了一项描述性现象学定性研究，对乌干达坎帕拉一家私立非营利性医院中12名经过目的抽样选取的开处方者（4名实习医生、6名医务人员和2名内科医生）进行了面对面深入访谈。录音和现场记录逐字转录，并通过内容分析进行人工分析。记录并报告了新出现的主题和子主题。
出现了三大主题：在乌干达使用抗菌药物的经验、合理抗菌药物处方的障碍和促进因素以及解决不合理抗菌药物使用的措施。参与者认识到抗生素经常被不合理使用，即使在感染的临床证据存在不确定性时也会开出处方，并且受到药品推广人员的影响，同时指出抗菌药物耐药水平很高。患者的症状和体征、以前使用抗生素的经验、对不良后果的恐惧、患者的需求和期望、资深同事的影响、临床检查的周转时间以及药品营销人员是抗菌药物处方的障碍和促进因素。开处方者也承认需要更新临床指南、建立医院抗菌谱，并提供关于合理使用抗菌药物的持续医学教育。
内在和外在因素的复杂相互作用影响了这家医院的抗生素处方决策。需要通过对开处方者进行持续教育和培训、提供当地处方指南和抗菌谱以及实施非处方抗生素销售监管等有针对性的干预措施，来实施强有力的抗菌药物管理计划，以成功遏制抗菌药物耐药性。
