Hospital Pharmacists’ Viewpoint on Quality Use of Antibiotics and Resistance: A Qualitative Exploration from a Tertiary Care Hospital of Quetta City, Pakistan

Abstract

Suboptimal antibiotics use and the development of antibiotic resistance is a universal calamity. The theoretical model of therapeutic efficacy correlates quality use of antibiotics with healthcare practitioners’ understanding of antibiotic use and resistance. Keeping this phenomenon in mind, we aimed to evaluate hospital pharmacists’ understanding of antibiotic use and resistance at a public healthcare institute in Quetta city, Pakistan. This was a qualitative study that employed a semi-structured interview guide for data extraction. The phenomenology-based approach commissioned in-depth, face-to-face interviews with hospital pharmacists stationed at the surgical unit of Sandeman Provincial Hospital, Quetta. The interviews were audio taped followed by transcribed verbatim and were then analyzed for thematic contents by the standard content analysis framework. Although the saturation was reached after the 10th interview, we conducted two additional interviews for definite validation. Content analysis revealed five major themes: (1) Defining antibiotics, quality use of antibiotics and resistance, (2) antibiotic use: awareness and concern, (3) antimicrobial resistance: awareness and concern, (4) responding to antibiotic use and resistance, and (5) barriers to quality use of antibiotics and prevention of antibiotic resistance. The knowledge of quality use of antibiotics and resistance was promising, and the respondents were eager to address the drastic situation. The respondents were aware of the critical situation and provided valuable insights that can offer valued input while promoting the quality use of antibiotics in a developing country. The current study managed to identify an adequate understanding of antibiotic use and resistance among hospital pharmacists. Additionally, prospective concerns and possible predictors of antibiotic resistance were also highlighted. The current findings must be disseminated to the policymakers and prescribers to take prompt restorative actions to address antibiotic use and the development of antibiotic resistance in a developing country like Pakistan.

Drivers of inappropriate use of antimicrobials in South Asia: A systematic review of qualitative literature

“…A patient’s decision to self-treat is informed by the perception that antimicrobials work based on prior therapeutic success with antimicrobials in themselves, family, or friends. Antimicrobials for self-treatment are obtained by receiving medication from a friend or family member, using leftover medication, or directly obtaining medication without a prescription from a pharmacy [ 65 , 74 , 75 , 78 ].…”

“…Studies described a multitude of systemic barriers to accessing the formal health care system, including rural areas with limited infrastructure, long wait times, poor quality of care, an inability to pay for services, or the complexity of navigating health systems [ 73 , 74 , 87 ]. Instead of accessing formal care, many patients reported that they instead relied on informal drug vendors who ran small drug stores that provided consultations and dispensed medications [ 65 , 72 , 74 , 75 ].…”

“…In a study of ASP development and implementation in India, conducted interviews with clinical providers in India and noted a lack of national infrastructure to legislate and control access to antimicrobials; strong local leadership and championing was necessary to make up for this PLOS GLOBAL PUBLIC HEALTH shortcoming and create successful ASPs [98]. Similar concerns about regulation and surveillance were identified in Pakistan among physicians [50] and pharmacists [65]. The study by indicated several barriers in ASP implementation in hospitals, which could be overcome if the government were to provide necessary support, including legislation and funding [50].…”

“…The high value placed on antimicrobials and belief in their power leads patients to expect and even demand antimicrobials when seeking medical care [87][88][89]. Patients will "doctor shop" or seek care only from providers who are known to readily provide antimicrobials or pharmacies that are liberal with their distribution [65,[90][91][92].…”

Drivers of inappropriate use of antimicrobials in South Asia: A systematic review of qualitative literature

“…Patients will "doctor shop" or seek care only from providers who are known to readily provide antimicrobials or pharmacies that are liberal with their distribution (65,(90)(91)(92).…”