Reali Savannah, Kwang Yee Chin, Cho Jin-Gun, Alffenaar Jan-Willem, Aslani Parisa
School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
Pharmacy Department, Prince of Wales Hospital, Randwick, Australia.
Br J Clin Pharmacol. 2025 May;91(5):1330-1351. doi: 10.1002/bcp.70011. Epub 2025 Mar 12.
Inappropriate and overuse of antimicrobials is increasing antimicrobial resistance. Understanding physicians' antimicrobial decision-making is essential for developing interventions to optimize prescribing. The aim of this review was to identify the factors that influence physicians' antimicrobial prescribing decisions. A systematic literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Embase, Medline and Scopus were searched from 2014 onwards using three key concepts: antimicrobial, prescribing and attitude. The search identified 11 038 articles for review. Studies were included if they used qualitative methods and obtained data directly from physicians. Factors influencing antimicrobial prescribing were extracted and categorized into physician-related, patient-related, medication- and condition-related, and external factors. A model of the antimicrobial prescribing process was created to illustrate how these factors influence decision-making. Fifty-three articles from 23 countries met the inclusion criteria. Forty factors influencing antimicrobial prescribing were identified, with the most common being time pressures, patient/carer demand for antimicrobials, diagnostic uncertainty, clinical experience, and the use of evidence-based guidelines and diagnostic tests. The harm to the patient and the physician of underprescribing were considered to outweigh the potential population harm of antimicrobial resistance due to overprescribing. Antimicrobial decision making is a complex process influenced by many different types of factors at each point in the prescribing journey. Awareness of these factors is vital for the success of interventions aiming to optimize antimicrobial prescribing. Future interventions should investigate how to balance individual and population harm whilst considering the individual factors that influence prescribing decisions.
抗菌药物的不当使用和过度使用正在增加抗菌药物耐药性。了解医生的抗菌药物决策对于制定优化处方的干预措施至关重要。本综述的目的是确定影响医生抗菌药物处方决策的因素。根据系统评价和荟萃分析的首选报告项目指南进行了系统的文献检索。从2014年起，使用三个关键概念在Embase、Medline和Scopus数据库中进行检索：抗菌药物、处方和态度。检索共识别出11038篇文章以供综述。如果研究采用定性方法并直接从医生处获取数据，则纳入研究。提取影响抗菌药物处方的因素，并将其分为与医生相关、与患者相关、与药物和病情相关以及外部因素。创建了一个抗菌药物处方过程模型，以说明这些因素如何影响决策。来自23个国家的53篇文章符合纳入标准。确定了40个影响抗菌药物处方的因素，最常见的是时间压力、患者/护理人员对抗菌药物的需求、诊断不确定性、临床经验以及基于证据的指南和诊断测试的使用。与过度处方导致的抗菌药物耐药性对人群的潜在危害相比，处方不足对患者和医生的危害被认为更大。抗菌药物决策是一个复杂的过程，在处方过程的每个环节都受到许多不同类型因素的影响。了解这些因素对于旨在优化抗菌药物处方的干预措施的成功至关重要。未来的干预措施应研究如何在考虑影响处方决策的个体因素的同时，平衡个体和人群的危害。
