Doctors are influenced by "prescribing etiquette" when deciding whether to give a patient antibiotics, according to new research.

The cultural rules within doctors’ specialties most strongly dictate their decision to prescribe antibiotics, researchers at the National Centre for Infection Prevention and Management (CIPM) at Imperial College London found in interviews with doctors, nurses and pharmacists.

What factors influence antibiotic use in hospitals?

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Policies designed to guide the use of antibiotics in hospitals would only succeed in changing doctors’ behaviour if they actively involved opinion leaders from different specialties and considered the culture that doctors work in, the researchers conclude.

About a third of patients in NHS hospitals are on antibiotics at any given time. The growing crisis of antibiotic resistance means doctors are under increasing pressure to cut down on their use.

Esmita Charani, the study’s lead author, said although hospitals expect doctors to follow policies on antimicrobial stewardship, doctors feel strongly about being able to have the final say on treatments their patients receive, regardless of evidence.

“What we found is, doctors tell us they rely on their own clinical judgement, and where that’s lacking or it’s still being developed, they look up to their seniors. We found a strong influence of senior doctors on the behaviour of their juniors.

“When we develop our policies, it’s very important to include local experts within specialties, so people who we expect to follow those policies are reassured that the policies have been developed with consensus from their peers and colleagues within specialties.”

Professor Alison Holmes, co-director of CIPM and senior author, said the question of how to address prescribing behaviours without compromising care has not been addressed adequately.

“It’s critically important that we get this right and understand what we’re doing and what works,” she said. “Unfortunately, the evidence base for this has been almost non-existent. That is why we’re very lucky at CIPM, funded by the UKCRC, to have the opportunity to look at this in some depth.”

The study is published in Clinical Infectious Diseases and was supported by the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre.

Listen to the full interview with Esmita Charani and Professor Holmes.

Reference

E Charani et al. ‘Understanding the Determinants of Antimicrobial Prescribing Within Hospitals: The Role of “Prescribing Etiquette”’ Clin Infect Dis. (2013) doi: 10.1093/cid/cit212