Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa

Tarrant, Carolyn; Colman, Andrew M.; Jenkins, David R.; Chattoe-Brown, Edmund; Perera, Nelun; Mehtar, Shaheen; Nakkawita, W.M.I. Dilini; Bolscher, Michele; Krockow, Eva M.

doi:10.3390/antibiotics10010094

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Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa

^1,*

⁴,

³,

⁵,

W.M.I. Dilini Nakkawita

⁶,

Michele Bolscher

⁵ and

Eva M. Krockow

Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK

Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7RH, UK

Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK

⁴

School of Media, Communication and Sociology, University of Leicester, Leicester LE1 7JA, UK

⁵

Tygerberg Academic Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town 7505, South Africa

⁶

Department of Clinical Microbiology, Faculty of Medicine, General Sir John Kotelawala Defence University, Dehiwala-Mount Lavinia 10390, Sri Lanka

Author to whom correspondence should be addressed.

Academic Editor: Albert Figueras

Antibiotics 2021, 10(1), 94; https://doi.org/10.3390/antibiotics10010094

Received: 17 December 2020 / Revised: 8 January 2021 / Accepted: 18 January 2021 / Published: 19 January 2021

(This article belongs to the Special Issue Antimicrobial Stewardship in Secondary Care across Different Resource Settings)

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Abstract

Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions. View Full-Text

Keywords: antimicrobial stewardship; antibacterial agents; hospitals; physicians; decision making; qualitative methods; UK; South Africa; Sri Lanka

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

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MDPI and ACS Style

Tarrant, C.; Colman, A.M.; Jenkins, D.R.; Chattoe-Brown, E.; Perera, N.; Mehtar, S.; Nakkawita, W.M.I.D.; Bolscher, M.; Krockow, E.M. Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa. Antibiotics 2021, 10, 94. https://doi.org/10.3390/antibiotics10010094

AMA Style

Tarrant C, Colman AM, Jenkins DR, Chattoe-Brown E, Perera N, Mehtar S, Nakkawita WMID, Bolscher M, Krockow EM. Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa. Antibiotics. 2021; 10(1):94. https://doi.org/10.3390/antibiotics10010094

Chicago/Turabian Style

Tarrant, Carolyn, Andrew M. Colman, David R. Jenkins, Edmund Chattoe-Brown, Nelun Perera, Shaheen Mehtar, W.M.I. D. Nakkawita, Michele Bolscher, and Eva M. Krockow 2021. "Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa" Antibiotics 10, no. 1: 94. https://doi.org/10.3390/antibiotics10010094

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