OBJECTIVES

Antibiotic resistance is a global problem and it is more severe in developing countries where the burdens of infectious diseases are even higher. Research in developed countries suggest that antibiotic stewardship programmes can improve antibiotic prescribing. However, these interventions are not directly applicable to developing countries due to differences in healthcare systems.

The broad aim for the study is to identify potentially effective approaches to improve antibiotic prescribing patterns in hospitals in Nigeria. This will be achieved by an in initial assessment of current antibiotic prescribing patterns in the area and then further exploring the perceptions and views of relevant stakeholders in antibiotic prescribing.

METHODS

A mixed methods approach was used. The first phase was a retrospective survey with patient’s case notes using data collection forms. The second phase employed semi-structured interviews to assess stakeholders’ views on the use and prescribing of antibiotics. Interviews were audio recorded; transcribed and thematic analysis was employed. Study sites were a mix of secondary and tertiary care hospitals in Bayelsa State of Nigeria

RESULTS

This study finds that 72.2% of the antibiotics were prescribed empirically, due to poor compliance with treatment guidelines and limited use of laboratory sensitivity tests. Factors responsible for the prescribing practices include poor laboratories, lack of guidelines, high drug costs and lack of required antibiotics, patient’s pressure, clinician’s attitude and knowledge. Behaviour change interventions identified to improve current practice include training, monitoring and documentation, provision of guidelines and changes to the physical settings. These interventions were accepted for implementation by the stakeholders.

CONCLUSIONS

There is still inappropriate prescribing of antibiotics in the study area and the reasons for this have been highlighted. The study findings demonstrate a clear need for more training on antibiotic prescribing for prescribers. Interventions developed using the behaviour change wheel are likely to improve antibiotic prescribing in these settings.