Barriers and Enablers to Optimal Antimicrobial Use in Respiratory Tract Infections

Area of Science:

• Infectious Diseases
• Pharmacology
• Health Services Research

Background:

• Antibiotic use for respiratory tract infections is frequently suboptimal, contributing to antimicrobial resistance.
• Clinical guidelines are not consistently followed, necessitating an investigation into prescribing practices.

Purpose of the Study:

• Identify antimicrobial prescribing guidelines used in clinical practice.
• Describe healthcare professionals' perceptions of guideline compliance.
• Explore barriers and enablers to optimal antimicrobial prescribing for hospitalized patients with respiratory tract infections.

Main Methods:

• Qualitative semi-structured interviews were conducted with 17 healthcare professionals (antimicrobial stewardship pharmacists, respiratory, and infectious diseases specialists) in New South Wales, Australia.
• Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic coding.

Main Results:

• Participants primarily used a national online guideline, finding it accessible but too verbose and lacking comprehensive information.
• Variable perceptions of guideline compliance existed between pharmacists and physicians.
• Key barriers included inadequate diagnostics, staffing shortages, treatment pressures, and knowledge deficits, while enablers involved strong stewardship teams, feedback mechanisms, and improved decision support tools.

Conclusions:

• National guidelines exist but adherence is inconsistent, impacting antimicrobial stewardship.
• Addressing barriers such as diagnostic limitations, resource constraints, and knowledge gaps is crucial for improving prescribing.
• Interventions focusing on education, feedback, and enhanced decision-support tools are recommended to optimize antimicrobial use.