Barriers to Antimicrobial Prescribing Changes

Antimicrobial resistance remains a global challenge that is not under control. Countries from around the world, including the UK, have developed action plans to counteract this silent pandemic. In the UK, such action plans include antimicrobial stewardship with strategies on early intravenous (IV) to oral antibiotic delivery switch. However, it is evident that despite all this guidance, there are still various barriers or myths preventing the switch. A literature search of studies and other reviews from the past 25 years on the topics of antimicrobial Intravenous-to-Oral Switch (IVOS) was conducted. The literature was reviewed and presented thematically to address perceived myths regarding IVOS. Several studies show that there are various reasons why early IVOS is restricted. Some of these beliefs, or myths, are shared between both the patients and clinicians, such as that IV antimicrobials are superior to the oral options. Some of these barrier beliefs stem from gaps in knowledge about the pharmacology of antibiotics and microbiology, leading to unnecessary IV therapy for resistant organisms. Excessive reliance on inflammatory markers exclusively to measure the severity of an infection is another barrier. Other common myths amongst clinicians are that IV antimicrobials are safer for patients, have no environmental impact, and that they have minimal impact on the clinical team and healthcare organisation. The fear of litigation from the patients for switching early, as well as the hierarchical system for decision making, are other limitations. Although IVOS is not for everyone, it is very evident that there is a lack of awareness about the existing guidance and the risks of not switching when appropriate. All of this is reflected in the beliefs and myths shared by the prescribing clinicians, and more needs to be done to change these views.