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Changes in antimicrobial prescribing behavior after the introduction of the antimicrobial stewardship program: A pre- and post-intervention survey

Ruchir Chavada, Harry N. Walker, Deborah Tong, Amy Murray
  • Ruchir Chavada
    Department of Microbiology and Infectious Diseases, Pathology North Central Coast, NSW, Australia |
  • Harry N. Walker
    Division of Medicine, Central Coast Local Health District, NSW, Australia
  • Deborah Tong
    Pharmacy Department, Central Coast Local Health District, NSW, Australia
  • Amy Murray
    Pharmacy Department, Central Coast Local Health District, NSW, Australia


The introduction of an antimicrobial stewardship (AMS) program is associated with a change in antimicrobial prescribing behavior. A proposed mechanism for this change is by impacting the prescribing etiquette described in qualitative studies. This study sought to detect a change in prescribing attitudes 12 months after the introduction of AMS and gauge utility of various AMS interventions. Surveys were distributed to doctors in two regional Australian hospitals on a convenience basis 6 months before, and 12 months after, the introduction of AMS. Agreement with 20 statements describing attitudes (cultural, behavioral and knowledge) towards antimicrobial prescribing was assessed on a 4-point Likert scale. Mean response scores were compared using the Wilcoxon Rank sum test. 155 responses were collected before the introduction of AMS, and 144 afterwards. After the introduction of AMS, an increase was observed in knowledge about available resources such as electronic decision support systems (EDSS) and therapeutic guidelines, with raised awareness about the support available through AMS rounds and the process to be followed when prescribing restricted antimicrobials. Additionally, doctors were less likely to rely on pharmacy to ascertain when an antimicrobial was restricted, depend on infectious diseases consultant advice and use past experience to guide antimicrobial prescribing. Responses to this survey indicate that positive changes to the antimicrobial prescribing etiquette may be achieved with the introduction of an AMS program. Use of EDSS and other resources such as evidence-based guidelines are perceived to be important to drive rational antimicrobial prescribing within AMS programs.


Antimicrobial stewardship, AMS, behavior, interventions

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Submitted: 2017-06-16 11:54:58
Published: 2017-10-02 11:26:21
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Copyright (c) 2017 Ruchir Chavada, Harry N. Walker, Deborah Tong, Amy Murray

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