Explanation of Physicians' Decision to Prescribe Meropenem : Case Study of a Hospital in Southern Thailand

Abstract

Objective: To study the explanation of meropenem prescribing from practicing physicians’ perspectives and experiences in hospital. Methods: This research was a qualitative study collecting the data using an in-depth interview in 9 physicians who prescribed meropenem for at least 10 times a year. Results: Meropenem prescribing could be explained by the following 5 reasons 1) high severity of the disease or patients’ symptoms including meningitis, septic shock, sepsis with multiple organ failure, and maternal sepsis, 2) expectation of better treatment outcomes when patients’ symptoms did not improved after treatment with other antibiotics in empirical treatment and specific treatment, 3) limitations of the use of other medications resulting from patient and medication factors, 4) loss  of confidence in microbiology laboratory process and report e.g. specimen collection process, gram stain reading, susceptibility results and 5) lack of experience of using  meropenem sparing antibiotics. Additional factor that force the physicians to prolong use of meropenem was the delay of microbiology laboratory report. Even though some of their decision sound justified, those decision were evaluated as “not appropriate” per the hospital criteria for meropenem indication. The physicians chose to prescribe meropenem dose of 1 g every 8 hours for both severe and non-severe infection cases.  Except in meningitis that meropenem was prescribed 2 g q 8 hour. Most physicians notified that they did not prescribe loading dose.  Duration of treatment mentioned by the physicians for meningitis and other infections were 14-21 and 7-14 days, respectively. Conclusion: Most informants prescribed meropenem based on the fear of patient worst outcomes. They used patients’ clinical data and microbiological data as the key information to make decision. We suggested these interventions should be done by hospital executive administrators to promote rational use of meropenem in the hospital 1) modify criteria for meropenem’s indication to make it more explicit and evidence based. Additionally, criteria should be guided by local antimicrobial susceptibility data. 2) acquire the automated antimicrobial susceptibility testing to expedite and improve microbiological laboratory process and report. 3) support the training regarding rational use of antimicrobial therapy for related health care professionals.