Physicians’ knowledge, perceptions and behaviour towards antibiotic prescribing: a systematic review of the literature

Abstract

Background: Knowledge, perceptions and prescribing behaviour are key to antibiotic prescribing. The aim of this paper is to systematically review this. Method: An extensive literature search from 1990 to 2014. Results: Nineteen articles were included; eight in ambulatory care, seven in hospital settings and four in both, across all countries. Physicians still have inadequate knowledge and misconceptions about antibiotic prescribing. Moreover, some physicians, although aware that antibiotics are of limited benefit in some conditions, still prescribed them. Several factors influenced prescribing, including patients’ expectations, severity and duration of infections, uncertainty over diagnosis, potentially losing patients and influence of pharmaceutical companies. Pocket-sized guidelines seen as an important source of information for physicians. Conclusion: Inadequate knowledge of prescribing is prevalent among physicians. However, many physicians were interested in improving their antibiotic prescribing. Multifaceted interventions targeting all key stakeholders, including patients, are needed to improve future antibiotic prescribing.

Keywords:

• antibiotics
• irrational use of medicines
• patients
• physicians
• prescribing behaviour
• resistance
• systematic reviews

Financial & competing interests disclosure

Faridah Aryani Md Yusof is employed by the Ministry of Health in Malaysia. Otherwise the authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript

Key issues

• Understanding physicians’ knowledge regarding antibiotics, how this knowledge is acquired and maintained, as well as factors influencing the prescribing of antibiotics is key to introducing future strategies to enhance the rational use of antibiotics. As a result, it helps reduce future resistance development.

• A systematic review was undertaken to assess current knowledge to provide future direction. This eventually involved 19 papers from 1633 titles and abstracts once only pertinent papers were included. The studies were across healthcare sectors and involved both developed and developing countries.

• The main findings showed that some physicians still have inadequate knowledge and misconceptions about antibiotic prescribing. In addition, although aware that antibiotics were of limited benefit or unnecessary for some conditions, they were still prescribed.

• Influencers of physician prescribing included patients’ requests and expectations, severity and duration of infections, belief that antibiotics can prevent secondary bacterial infections, uncertainty between bacterial or viral infections, potential losing of patients if antibiotics are not prescribed, influence of pharmaceutical companies and limited access to information sources on antibiotic prescribing.

• Pocket-size guidelines were seen as the most important source of information on antibiotic prescribing. This along with future training and feedback will help improve future antibiotic prescribing.

• Educating patients is also important to improve the future rational use of antibiotics.