Research Output
Understanding the complexities of antibiotic prescribing behaviour in acute hospitals: a systematic review and meta-ethnography
  Background: Antimicrobial resistance poses a serious global public health threat. Hospital misuse of antibiotics has
contributed to this problem and evidence-based interventions are urgently needed to change inappropriate
prescribing practices. This paper reports the first theoretical stage of a longer-term project to improve antibiotic
prescribing in hospitals through design of an effective behaviour-change intervention.
Methods: Qualitative synthesis using meta-ethnography of primary studies reporting doctors’ views and
experiences of antibiotic prescribing in hospitals for example, their barriers to appropriate prescribing. Twenty
electronic databases were systematically searched over a 10-year period and potential studies screened against
eligibility criteria. Included studies were quality-appraised. Original participant quotes and author interpretations
were extracted and coded thematically into NVivo. All study processes were conducted by two reviewers working
independently with findings discussed with the wider team and key stakeholders. Studies were related by findings
into clusters and translated reciprocally and refutationally to develop a new line-of-argument synthesis and
conceptual model. Findings are reported using eMERGe guidance.
Results: Fifteen papers (13 studies) conducted between 2007 and 2017 reporting the experiences of 336 doctors of
varying seniority working in acute hospitals across seven countries, were synthesised. Study findings related in four
ways which collectively represented multiple challenges to appropriate antibiotic medical prescribing in hospitals:
loss of ownership of prescribing decisions, tension between individual care and public health concerns, evidence-based practice versus bedside medicine, and diverse priorities between different clinical teams. The resulting new
line-of-argument and conceptual model reflected how these challenges operated on both micro- and macro-level,
highlighting key areas for improving current prescribing practice, such as creating feedback mechanisms,
normalising input from other specialties and reducing variation in responsibility for antibiotic decisions.

  • Type:


  • Date:

    23 July 2021

  • Publication Status:


  • Publisher

    Springer Science and Business Media LLC

  • DOI:


  • Cross Ref:


  • Funders:

    Edinburgh Napier Funded


Wojcik, G., Ring, N., McCulloch, C., Willis, D. S., Williams, B., & Kydonaki, K. (2021). Understanding the complexities of antibiotic prescribing behaviour in acute hospitals: a systematic review and meta-ethnography. Archives of Public Health, 79(1),



Antimicrobial resistance, Antibiotic decision-making, Prescribing behaviour, Doctors, Acute hospitals, Meta-ethnography, Qualitative synthesis

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