Factors Influencing Inappropriate Use of Antibiotics in Infants under 3 Years of Age in Primary Care: A Qualitative Study of the Paediatricians’ Perceptions

Abstract

Antibiotic consumption in infants of less than three years is higher than average the average consumption for general population. The aim of this study was to explore paediatricians’ opinions regarding factors influencing inappropriate use of antibiotics in early infancy in primary care. A qualitative study based on the grounded theory using convenience sampling was conducted in Murcia Region, Spain. Three focal discussion groups were developed with 25 participants from 9 health areas (HA) of Murcia Region. Paediatricians perceived that health care pressure was an influential factor in the prescribing behaviour, forcing them to prescribe antibiotics for a rapid cure in unjustified circumstances. Participants believed that antibiotic consuming was related to parents’ self-medication due to their perceptions about the curative potential of antibiotics together with facilities to obtain these agents from pharmacies without prescription. The misuse of antibiotics by paediatricians was associated to the lack of education on antibiotic prescription and the limited use of clinical guidelines. Not prescribing an antibiotic in the presence of a potentially severe disease generated more fear than an unnecessary prescription. The clinical interaction asymmetry was more evident, when paediatricians use trapping risk strategies as a mechanism to justify a restrictive prescribing behaviour. The rational model of clinical decision-making in antibiotic prescribing among paediatricians was determined by factors associated with health care management, social awareness and knowledge of the population and pressure of families’ demands. The present findings have contributed to the design and implementation of health interventions in the community for improving awareness of the appropriate use of antibiotics, as well as for a better quality of prescription by peadiatricians.

Public knowledge, attitudes, and practices (KAP) regarding antibiotics use and antimicrobial resistance (AMR) in Bangladesh

“…The socio-economic determinants identified in this study align with previous research. Education emerged as a significant factor influencing KAP, consistent with findings from various studies conducted in different settings [ [38] , [39] , [40] ]. This highlights the crucial role of education in improving knowledge, attitudes, and practices related to antibiotics use and AMR.…”

Implementation of a Multifaceted Program to Improve the Rational Use of Antibiotics in Children under 3 Years of Age in Primary Care

“…The prescribing physicians are also influenced by a high workload in consultations, family pressure for antibiotic prescription, parental anxiety, insecurity of non-prescription, fear of losing patients, and insufficient knowledge [17,30,31]. In a previous qualitative study of our group, the misuse of antibiotics by pediatricians was also associated with poor knowledge and limited use of clinical practice guidelines [17].…”

“…Qualitative and quantitative studies have identified different factors associated with variability in antibiotic consumption, such as the prescription policies, the role of community pharmacies in dispensing antibiotic agents without prescriptions, the pharmaceutical market, the economic and sociocultural factors, the management models of healthcare systems, and the prescribing physicians themselves [11,28]. The prescribing physicians are also influenced by a high workload in consultations, family pressure for antibiotic prescription, parental anxiety, insecurity of non-prescription, fear of losing patients, and insufficient knowledge [17,30,31]. In a previous qualitative study of our group, the misuse of antibiotics by pediatricians was also associated with poor knowledge and limited use of clinical practice guidelines [17].…”

“…Although a consolidated standardized strategy for improving appropriate antibiotic use in pediatric populations is lacking, there is a consensus on the need of a combined and integrated approach targeting healthcare professionals, families and patients, and social and organizational environments [17,32]. The PURAPI program was based on a multifaceted, participatory, open, and dynamic approach, focusing on the identification of barriers and facilitating elements, while advocating the best practices within the workplace.…”

“…According to data from the European Center for Disease Prevention and Control (ECDC), the percentage of antibiotic consumption in Spain, both in hospitals and primary care centers, is one of the highest compared to other European countries, with increases in the daily dose per 1000 inhabitants per day (DHD) of up to 23.2 in 2022, making Spain seventh in antibiotic consumption in Europe [14]. The causes underlying this high antibiotic consumption in Spain have not been fully elucidated, although influences on the behavior of prescribing clinicians may include factors related to healthcare overload, fear professionals have not to prescribe them uncertainty about diagnosis, desire to please patients, induced prescriptions derived from emergency services and private practice, low cost of antibiotics, and lack of social consciousness about the responsible use of antibiotics [15][16][17]. Regarding the consumption of antibiotics in children under 3 years of age, there are no official national data in Spain [18], although there is evidence suggesting high antibiotic use in this age group [10].…”