title: A review of the factors influencing antimicrobial prescribing.
abstract: There are multiple benefits of appropriate antimicrobial prescribing: it has a direct impact on clinical outcomes, avoids adverse effects, is cost effective and, perhaps most importantly, it helps to prevent the emergence of resistance. However, any physician can prescribe antibiotics, which is not the case with other clinically relevant drugs. There is great variability in the prescribing physician's (PP) training, motivation, workload and setting, including accessibility to infectious diseases consultants and/or diagnostic techniques, and therefore there is a high risk of inappropriate prescription. Many antibiotic prescribing errors occur around the selection and duration of treatment. This includes a low threshold for the indication of antibiotics, delayed initiation of treatment when indicated, limited knowledge of local antimicrobial resistance patterns by the PPs, errors in the final choice of dose, route or drug and a lack of de-escalation. Similarly, the prescription of prophylactic antibiotics to prevent surgical site infections, despite being commonly accepted, is suboptimal. Factors that may explain suboptimal use are related to the absence of well-defined protocols, poor knowledge of prophylactic protocols, miscommunication or disagreement between physicians, logistical problems, and a lack of audits. A proper understanding of the prescribing process can guide interventions to improve the PP's practices. Some of the potential interventions included in a stewardship program are education in antimicrobial prescribing, information on the local resistance patterns and accessibility to a qualified infectious diseases consultant.
authors.affiliation: Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain; Departamento de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain. Electronic address: ecalbo@mutuaterrassa.es.
authors.forename: Esther
authors.initials: E
authors.lastname: Calbo
authors.forename: Luis
authors.initials: L
authors.lastname: Alvarez-Rocha
authors.forename: Francisco
authors.initials: F
authors.lastname: Gudiol
authors.forename: Juan
authors.initials: J
authors.lastname: Pasquau
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D011307:Drug Prescriptions / Q000592:standards*; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial prescribing process; Antimicrobial stewardship; Determinantes del uso de antibióticos; Determinants of antibiotic use; Drug resistance; Inappropriate prescribing; Optimización del uso de antibióticos; Prescripción inadecuada; Proceso de prescripción de antibióticos; Resistencia al fármaco