Knowledge, practices, and influencers of antibiotic prescriptions of Nigerian doctors

Abstract

Background: There is a dire need to preserve antibiotics currently in use to avert resistance. Appropriate use of antibiotics would ensure antimicrobial stewardship. Doctors are in the forefront of prescriptions. Their knowledge of and proper prescription practice as well as what influences their antibiotic prescriptions go a long way in mitigating antimicrobial resistance.
Aim: To ascertain the knowledge, practices and influencers of antibiotic prescriptions of doctors in Nigeria.
Methods: An online self-administered questionnaire on aspects of knowledge of when to prescribe antibiotics, actual prescription practice, and factors that influence prescription, was employed. Questionnaires were sent out in doctors’ social media groups as google forms soliciting for responses. Responses were automatically entered into google spreadsheets and data analysed using SPSS version 21.
Results: A total of 258 doctors responded. The overall mean (SD) knowledge score (%) was 66.0±9.3 with a range of 40.0-93.3. Family physicians and paediatricians had higher mean knowledge scores than those in other specialities (p<0.001). The overall mean appropriate practice score was 66.8±8.4 with a range of 40.0-85.7. The mean proper practice scores were highest among the family physicians, paediatricians and public health physicians (p=0.002). The greater the years of medical practice the more the mean knowledge score (p=0.007) and likewise doctors in tertiary care knew more than those in secondary and primary care (p=0.002). Possession of prior information on antibiotic stewardship resulted in higher knowledge (p<0.001) and practice (p=0.015) scores, while having facility antibiotic protocols/ antibiotic stewardship committees was akin to better knowledge (p=0.032) and prescription practice (p=0.012). There was a weak though statistically significant positive linear relationship between knowledge and practice scores (rs=0.291, p<0.001. Knowledge accounted for only 9.2% (R2=0.092) of variability in practice scores. A 1% increase in knowledge score increased practice score by 0.3%. Major influencers of prescribing practice were history of prior use of antibiotics by the patient (97.3%), cost of antibiotics intended to be prescribed (95.3%), age of patient (93.1%), request for antibiotics by the patient (89.6%), and patients presenting with high fevers (70.5%).
Conclusion: Demographic characteristics of respondents influenced knowledge but not necessarily practice. Knowledge of appropriate antibiotic prescription had little effect on actual prescribing practice. The factors that affected prescribing practice were previous training on AMS and availability of institutional protocols and treatment guidelines. It is recommended that all medical practitioners receive training on AMS and adhere to institutional treatment protocols.