Facilitators of inappropriate antibiotic prescription for respiratory tract infections: A qualitative study in Jinja City -Uganda

Abstract

Introduction Inappropriate use of antibiotics is the major cause of antibiotic resistance (ABR) which is a public health threat today and predicted to worsen in future. Most respiratory tract infections (RTIs) are caused by viruses and do not require treatment with antibiotics. High rates of antibiotic use in RTIs have been confirmed by various studies. Few studies had been conducted in Uganda to determine why prescribers continue to prescribe antibiotics for RTIs. We set out to determine the facilitators of antibiotic prescription (ABP) for RTIs in Jinja City. Methods 16 prescribers had their views explored by interviewing them using an in-depth interview guide for which responses were voice recorded. The voice recorded responses were transcribed manually, analyzed and summarized into themes and subthemes. Results We found that inappropriate prescription for RTIs was influenced by prescriber perceptions about the patient, prescriber intrinsic factors, interpersonal relations, health system factors. At patient level, prescribers considered patients with severe RTIs, prolonged symptoms, those re-attending with similar symptoms, non-responsiveness to supportive treatment, young and elderly and immune compromised patients as reasons for immediate prescription of antibiotics. The prescribers’ intrinsic factors that influenced ABP were prescribers’ age and clinical experience, skepticism about Uganda clinical guidelines (UCG), misconceptions about the causes of RTIs. Interaction with medical representatives and perception of patient expectation as well as direct demand from patients influenced ABP at interpersonal level. The health system facilitators of ABP were: inaccessible and inconvenient to use UCG, limited continuous training of prescribers on antibiotic use, lack of prescribing audit and support supervision, focus on prescribing rather than patient education and unavailability of point care tests (POCTs), stock out of first line treatment medicines and availability of huge stocks of nearly expiring antibiotics. Conclusion We found that several factors interplayed to determine the inappropriate antibiotic prescription for RTIs in Jinja City. Increasing prescribers’ awareness of ABR resistance and or improving availability of standard treatment guidelines can go a long way in solving the inappropriate prescribing challenge. There is need for dealing with several factors if this challenge is be controlled.