Antimicrobial prescribing and determinants of antimicrobial resistance : a qualitative study among physicians in Pakistan

Background: Understanding physicians’ perception about antimicrobial use and resistance is essential to ensure that the objectives of the Pakistan national action plan on antimicrobial resistance are met. Little is currently known about physicians’ perceptions in Pakistan. Objective: Assess physicians’ perception surrounding antibiotic use and resistance, factors influencing antibiotic prescribing and potential interventions to improve future antibiotic prescribing. Settings: The study was conducted in Lahore, the capital of the province of Punjab, which is the second largest and most populous city of Pakistan.Method: Qualitative study was conducted with a semi-structured interview guide involving in-depth face-to-face interviews with purposively selected physicians. Audio-recorded interviews were transcribed verbatim and transcripts analyzed by thematic content analysis. Main Outcome Measures: Themes surrounding the perspectives of physicians on issues of antimicrobial use and resistance. Results: Five major themes emerged: (1) knowledge and perception of physicians about antimicrobials, (2) antimicrobial prescribing behaviors of physicians, (3) factors influencing prescribing, (4) determinants of antimicrobial resistance, (5) and potential interventions to reduce antimicrobial resistance. The main challenges and issues associated with antibiotic prescribing were the improvement of knowledge, implementation of hygienic measures, access to and clarity of treatment recommendations and minimizing external factors influencing prescribing including pharmaceutical company activities. Suggestions for the future included stricter regulations for prescribing, improved diagnosis availability of local guidelines and monitoring of prescribing and resistance patterns. Conclusion: Identification of concerns regarding inappropriate antimicrobial prescribing will enable specific initiatives and approaches to improve future antimicrobial use and reduce antimicrobial resistance in Pakistan