Qualitative study identifies structural factors driving broad-spectrum antibiotic prescribing among healthcare staff in Singapore, Nepal, and Thailand.

This qualitative study examined contextual influences on antibiotic prescribing behavior among physicians, nurses, pharmacists, and management staff. Data were gathered through 194 interviews conducted across ten institutions located in Singapore, Nepal, and Thailand. The research aimed to understand the drivers of antimicrobial prescriptions within these specific healthcare settings.

The analysis revealed that structural factors significantly influenced prescribing practices. Key drivers for prolonged and broad-spectrum antibiotic prescriptions included limited microbiology laboratory capabilities, concerns regarding antibiotic quality, weak infection prevention and control policies, and a lack of relevant, updated guidelines. In environments where system supports were in place, prescribing decisions were observed to be less defensive and more targeted.

Clinician prioritization was also a critical finding. Prescribing practices were heavily influenced by prescriber responsibility and concerns about immediate patient deterioration. Consequently, clinicians tended to prioritize the short-term perceived benefits of antibiotic treatment over the longer-term risks associated with antimicrobial resistance. This suggests that immediate clinical pressures often outweigh broader public health considerations in daily practice.

The study provides actionable insights to improve prescribing behavior by highlighting the need to address underlying structural deficiencies. However, as a qualitative investigation, the findings describe observed associations and reported experiences rather than establishing causal relationships. The results reflect the perspectives of the interviewed staff and may not be generalizable to all settings without further quantitative validation.