Skip to main content
Download PDF

Knowledge and attitude of healthcare prescribers and pharmacists toward antimicrobial stewardship program and the barriers for its implementation

Antimicrobial Resistance & Infection Control volume 13, Article number: 35 (2024) Cite this article

Abstract

Background

Antimicrobial stewardship (ASP) is considered a key prevention strategy in addressing the worldwide concern of accelerating antimicrobial resistance. Limited research is available regarding healthcare providers’ knowledge and attitude toward antimicrobial stewardship and the barriers for its implementation.

Methods

The present cross-sectional study was conducted on pharmacists and healthcare prescribers (HCPs) in different hospital sites across Jordan. A validated survey was used to evaluate HCPs and pharmacists’ knowledge, and attitudes towards ASP and the barriers for its implementation. Logistic and linear regression were conducted to identify the factors associated with knowledge and attitude toward ASP, respectively.

Results

A total of 603 participants, 69 (11.4%) pharmacists and 534 (88.6%) HCPs completed the study questionnaire, with a response rate of 80.4%. The overall mean knowledge about ASP was 7.16 out of 10, ranging from 0 to 10 (SD 2.22). Being a pharmacist and increased awareness/familiarity about ASP were associated with improved ASP knowledge. The overall average attitude score was = 3.8 ± 0.49 (range: 1.8–4.8). Results revealed that being a pharmacist and improved knowledge were associated with improved attitude toward ASP. Lack of specialized staff with expertise in ASP and lack of access to education and training programs were the major barriers hinder ASP implementation.

Conclusion

Despite the reasonable knowledge and the positive attitude toward the ASP, several barriers were reported, particularly by the pharmacists. Therefore, promoting the presence of adequately skilled healthcare personnel, creating easily accessible online courses, and establishing a comprehensive database of ASP resources are all suggested approaches to improve the application of ASP in healthcare settings.

Introduction

Antimicrobials agents can treat many infectious diseases as they have the ability of not only improving a patient’s quality of life, but have proven to be improve survival in several severe infective conditions [1]. However, the inappropriate use of antimicrobial agents leads to the development of antimicrobial resistance (AMR) [2]. AMR is a major public health problem worldwide, which leads to increase in morbidity, mortality, and medical costs [2]. The World Health Organization predicts 10 million deaths in 2050 if the problem is not being addressed by all stakeholders [3]. The centre for disease prevention and control (CDC) estimated that AMR requires $20 billion direct healthcare costs and $35 billion due to loss of productivity annually [4]. In 2021, the CDC published first-ever estimates demonstrating that the yearly cost of treating infections caused by six multidrug-resistant bacteria in healthcare exceeds $4.6 billion in the United States [5].

Antimicrobial Stewardship Program (ASP) is considered a key prevention strategy in addressing the worldwide concern of accelerating AMR [6, 7]. A meta-analysis revealed that the application of hospital-based ASP was associated with several improvements in clinical and financial outcomes, including a decrease in the amount of antibiotics used, the total cost of antibiotics, the number of infections caused by a particular antibiotic-resistant pathogen, and the length of hospital stay [8].

The implementation of effective ASP programs requires a well-equipped and knowledgeable multidisciplinary healthcare team consisting of physicians, pharmacists, microbiologists, epidemiologists, and infectious disease specialists with sufficient experience in their respective fields [9]. Physicians play a critical role in shaping antimicrobial policy, crafting prescribing guidelines, and establishing antimicrobial approval structures [10], while pharmacists play an important role in the implementation of ASP via optimizing antibiotic selection and regimens [11]. To ensure their active engagement in such a process, it is imperative to understand their perspectives, knowledge, and attitudes towards ASP.

Limited research is available regarding healthcare providers’ understanding and perspectives regarding ASP in Jordan and worldwide. A previous study concluded that the Jordanian practitioners still need an educational intervention to improve their knowledge regarding ASP [12]. The current study aimed at exploring health care prescribers’ (HCPs) and pharmacists’ knowledge and attitudes toward ASP and the barriers for its implementation. Findings should provide an insight for health authorities to develop strategies and implement interventions for effective implementation of the ASP by the pharmacists and the HCPs at different clinical settings. Additionally, examining the knowledge and attitudes of HCPs regarding ASP can reveal areas where the multidisciplinary team collaboration and communication could be improved.

Methods

Study design and subjects

A cross sectional questionnaire-based study was conducted in the period from September through December 2021 using a convenience-sampling technique. The questionnaire was distributed in English via WhatsApp community groups that included only the HCPs and pharmacists in each study site and the survey access was restricted to the email addresses of the participants to mitigate the possibility of duplicate survey access. The HCPs were physicians of different specialities and dentists working at Royal Medical Services (RMS) hospitals (Prince Rashid Hospital and AL Hussein Hospital), King Abdullah University Hospital and Princess Basma Hospital. These hospital settings are classified as tertiary hospitals and located in the north and the middle of Jordan. The hospitals play a crucial role in delivering the majority of healthcare services to residents in these areas. In addition, the hospitals serve as a suitable representation of governmental, military, and educational hospitals in Jordan.

Study instrument

A custom-designed questionnaire was used to collect socio-demographics of the participants including age, gender, marital status, profession, education level, years of experience and department of work. The participants were also asked if they were aware/familiar with ASP or if they received a previous ASP training..

The 10-item knowledge part was designed after a thorough review of the relevant published studies [13, 14]. This part assessed the HCPs and pharmacists’ knowledge about different aspects of ASP using true, false and don’t know possible answers to each item. In scoring the questionnaire, each correct answer was given a score of one and each incorrect answer was given a score of zero. The answer “don’t know” was considered as incorrect. The scores were then summed for a total score ranging from 0 to 10. For the purpose of the present analysis, the participants were divided into two groups: those scoring more than the mean score were considered having sufficient knowledge about ASP, and those scoring less than the mean score were considered to have insufficient knowledge.

The 15-item attitude domain was adapted from earlier studies with rephrasing of some statements [14, 15]. The participants were asked to respond to this domain items using a five-point Likert scale ranging from strongly disagree to strongly agree. The positive attitude statements (items 1–7) were scored from 5 for strongly agree to 1 for strongly disagree, while the negative attitudes statements (items 8–10) were scored from 5 for strongly disagree to 1 for strongly agree. The mean attitude score was calculated for each statement where higher scores indicating more positive attitude.

The last part, which was adapted from an earlier Saudi study, [15] consisted of eight items evaluating the participants’ barriers to implement ASP. The participants were asked to answer the questions in this domain on a five-point Likert scale ranging from strongly disagree (score 1) to strongly agree (score 5). The survey was reviewed by experts in the field of infectious diseases including infection control physicians and professors in pharmaceutical microbiology and changes including rewording and refining the questionnaire were made where appropriate. Next, the survey was piloted on twenty HCPs and pharmacists to obtain feedback on the appropriateness of the questionnaire with regard to its content, length and suitability. Piloted sample was not included in the final analysis of this study.

Statistical analysis

Data were analysed and coded using the Statistical Package for the Social Sciences (IBM SPSS) version 25. Continuous variables were described in terms of mean (standard deviations), while categorical variables were described in terms of frequency and percentages. The independent sample t test or Chi-square test was used to investigate the association between different variables and the dichotomous outcome ASP knowledge. Binary logistic regression analysis was performed to identify significant and independent predictors of ASP knowledge. The independent sample t test, ANOVA, chi-square and Pearson correlation were used to find the association between different variables and the outcome attitude score as appropriate. Multiple linear regression was performed to explore factors independently associated with attitude score. Fisher exact test and chi square test were used to measure the difference between pharmacists and HCPs with regard to barriers reporting. Variables with a P value less than 0.2 in the univariate analysis were selected for inclusion in the multivariate regression models. A cut off P value < 0.05 was used to identify significant predictors of ASP knowledge and attitude in the multivariate models.

Results

Out of 750 HCPs and pharmacists who were invited to participate in the study, 603 participants, 69 (11.4%) pharmacists and 534 (88.6%) HCPs completed the study questionnaire, with a response rate of 80.4%. The mean age (SD) of the participants was 30.3 (0.24) years. Most of the study participants were males (71.3%), a quarter working in the surgery and urology departments (25.9%), and about half had less than or equal to four years of practice (57.4%). The majority did not receive a previous ASP training (92.5%), and about half were not aware about ASP (55.7%). Others sociodemographic characteristics of the participants are presented in Table 1.

Table 1 Sociodemographic characteristics of the study participants (n = 603)
Full size table

The mean knowledge score was 7.16 out of 10, ranging from 0 to 10 (SD 2.22). As shown in Table 2, the participants demonstrated sufficient knowledge about some aspects of ASP, particularly de-escalation therapy to avoid resistance (84.1%), the importance of the availability of experts in antimicrobial therapy (87.1%) and the necessity to receive regular feedback and evaluation from the experts on regular basis (83.1%). Other participants reported insufficient knowledge with other aspects, particularly knowledge about the role of ASP in reducing potential side effects (56.4%), and antimicrobial cycling (47.8%).

Table 2 Knowledge about ASP (n = 603)
Full size table

Results of the univariate analysis showed that being a pharmacist, increased years of experience, awareness about ASP, and having previous training on ASP were significantly associated with sufficient knowledge about ASP (P < 0.05). The practice site was not associated with knowledge of ASP (P = 0.728). As shown in Table 3, results of regression analysis showed that the odds of having sufficient ASP knowledge among pharmacists were 2.46 times the odds among the HCPs. Furthermore, the odds of having sufficient ASP knowledge among participants who had previous awareness about ASP were 2.72 the odds in those who were unaware about ASP.

Table 3 Multivariate logistic analysis of the factors associated with knowledge about ASP
Full size table

The overall mean attitude score was 3.8 ± 0.49, ranging from 1.8 to 4.8. As shown in Table 4, the participants demonstrated positive attitude toward different aspects of ASP. In particular, they believed that ASP is necessary to reduce AMR (86.9%) and to improve prescription practice (86.1%). They also believed that effective implementation of ASP requires the engagement of physicians and pharmacists who are expert in ASP (84.3%), and could provide clear instructions about antibiotic use (84.4%), particularly with regard to restriction of antimicrobial use (83.5%). Although most of participants believed that antimicrobial resistance could be minimized (80.3%) and they were willing to implement and improve ASP practice in their hospital setting (81.9%), the majority considered AMR as a challenging practice (55.9%) and they were not confident enough to prescribe antimicrobials according to ASP regulations (33.1%).

Table 4 Attitudes towards ASP (n = 603)
Full size table

Results of the univariate analysis showed that increased knowledge score, female gender, being a pharmacist, working in KAUH and the RMS hospital, increased years of experience, being unaware about ASP and not having previous training on ASP were significantly associated with improved attitude toward ASP (P < 0.05). As shown in Table 5, results of the multiple linear regression revealed that being a pharmacist increased the attitude score by 0.226 as compared with other ASP practitioners. Furthermore, each unit increase in the knowledge score was associated with 0.009 increase in the attitude score. Working at KAUH or the RMS hospital increased the attitude score by 0.095 and 0.115 respectively. On the other hand, having previous awareness about ASP and receiving training about ASP were negatively associated with ASP attitude score.

Table 5 Multivariate analysis of the factors associated with the attitude toward ASP
Full size table

The most commonly reported barriers for ASP implementation were lack of specialized staff (70%) and lack of education programs about ASP (67.4%). Except for lack of ASP understanding by the hospital administration and lack of financial support, all the other barriers were significantly more reported by the pharmacists when compared with other HCPs.

Discussion

The current study participants reported reasonably sufficient knowledge and they were willing to implement ASP in clinical setting. Nevertheless, the participants, particularly the pharmacists, reported several barriers for ASP implementation. When compared with a recent study conducted in Jordan and evaluated physicians and pharmacists’ attitudes and practice of ASP, [12] the present study should provide a deeper understanding and a broader insights about the information needs, and how the pharmacists and prescribers understand and perceive ASP in addition to the barriers they experience for ASP implementation.

Most of the current study participants were not conversant with ASP and did not receive a training on ASP and its implementation. A study conducted in a Ghanaian Tertiary Hospital reported that pharmacists, medical doctors, nurses and medical laboratory scientists who received a training on ASP showed an improved knowledge about ASP and AMR, which was demonstrated by reduced empirical antibiotic prescribing [7].

Although the participants showed sufficient knowledge about some aspects of ASP, some of the participants reported insufficient knowledge with regard to the role of ASP in reducing potential side effects, the defined daily dose (DDD), time-sensitive automatic stop orders strategy and antimicrobial cycling. An earlier study showed that restricting antibiotics use, which is recommended by the ASP, help controlling potential antibiotics side effect and AMR [14]. A study conducted in China showed that implementing DDD and time stop order strategy results in reduce antibiotic consumption [16]. Antibiotic cycling is a practice whereby multiple antibiotic classes are used in various hospital environments to minimize the emergence of resistance that might occur because of using a single or a limited number of antibiotic classes [17]. Several studies reported antibiotic cycling as one of the most effective strategies for reducing AMR and the potential side effects. A study conducted in France showed that the strategy of antibiotic rotation reduced the incidence of late-onset hospital-acquired pneumonia, reduced mortality, and reduced antibiotic resistance [18]. Other studies reported minimization of ventilator-associated pneumonia after antibiotic cycling among ICU patients [19, 20].

Results showed that being a pharmacist and increased awareness about ASP were significantly associated with improved ASP knowledge. Pharmacists are well versed in the pharmacology of antibiotics and they are expected to review prescriptions and advise physicians on the optimum selection of antibiotics [21]. The positive association between awareness and knowledge about ASP in the present study was also reported in earlier studies [6, 7, 14, 22].

Although the current study participants showed good attitude toward different aspects of ASP, some participants perceived antimicrobial resistance as a challenge in their daily practice and others were not confident in prescribing antibiotics without increasing antimicrobial resistance. An earlier study showed that the majority of the physicians and pharmacists believed that AMR is a major challenge in the clinical practice [23]. Another study showed that some of the participating HCPs were not confident about their knowledge and practice in the area of antimicrobial prescribing [15]. Although the majority of the current study participants believed that AMR can be controlled or minimized, higher percentages were reported in earlier studies [24]. The identified negative attitudes towards ASP implementation, as shown by participants’ responses to attitudes statements in Table 4, may be partially attributed to a lower number of years of clinical experience (less than 4 years) among some individuals.

Being a pharmacist and having sufficient knowledge about ASP were associated with improved attitude toward ASP. Consistent with the current study findings, an earlier study showed that the community pharmacists were more interested in the implementation of collaborative ASP strategies when compared with other health practitioners [25]. Also, KAUH and RMS hospitals are of the largest tertiary hospitals in the region that regularly provide training on different aspects of health services and programs including the ASP, which may justify the increased willingness of the pharmacists and other HCPs who work in these sites to implement ASP in the practice setting. The unexpected observation was the inverse relationship between awareness, training in ASP, and attitude scores. One possible explanation is that pharmacists and HCPs lacking awareness and training on ASP may exhibit greater enthusiasm in implementing the program, seeing it as a potential solution to the prevalent antimicrobial resistance challenges encountered in clinical practice. Conversely, individuals with ASP awareness or specialized training might encounter various obstacles during program implementation, leading to unmet expectations from ASP.

Despite the reasonably good attitude toward ASP, several barriers for ASP implementation were reported in the present study. The majority of the pharmacists and HCPs believed that the lack of ASP specialist staff, lack of access to education and training programs and lack of specialized ASP information resources were the most common barrier for ASP implementation, which agrees with previous findings [15, 26]. The specialist staff is needed to effectively develop the ASP and put appropriate polices for the management of infectious diseases [15]. Lack of knowledge and lower confidence of health care providers to provide ASP, lack of formulary management and funding, and lack of understanding of ASP by hospital administrators were also reported as barriers for ASP implementation in this study, which supports previous research findings [15, 17, 22, 27,28,29,30,31]. When compared with the HCPs, pharmacists in the current study significantly reported more barriers for ASP implementation. An earlier study showed that pharmacists reported high recognition of the importance of the ASP and its impact on reducing the use of antimicrobial agents and the cost of treatments [32].

Strengths and limitations

The current study was conducted on a large sample of participants, including both pharmacists and HCPs, which enhances conclusions that are more robust. In addition, utilizing a validated survey instrument enhances the validity and reliability of the data gathered, thereby boosting the accuracy of the results. Moreover, the knowledge gained from this study provides important direction for upcoming antimicrobial resistance prevention initiatives, and helps in developing effective strategies to minimize AMR and maximize the application of ASP in clinical settings. On the other hand, the current study did not cover all the Jordanian provenances that might limit the generalizability of the findings. The scope of the study was confined to HCPs and pharmacists. It is recommended that future studies broaden their scope to include additional health professions such as nurses who play an integral role in infection prevention and control, and providing collaborative healthcare services. Lastly, the self-reported questionnaire used for data collection could have overestimated responses due to misunderstanding bias.

Conclusions

The current study showed a margin for improvement in HCPs and pharmacists’ knowledge and attitudes toward the ASP. Healthcare authorities and hospitals administrators should ensure the availability of well-equipped healthcare staff by providing regular educational and training programs, which aim at fulfilling HCPs and pharmacists’ knowledge gaps and improve attitudes toward ASP. The authorities should also focus on overcoming the barriers for ASP implementation in order to enhance the implementation of effective ASP in different healthcare settings in Jordan. This includes the development of accessible online courses, providing individuals with the flexibility to learn at their own. In addition, promoting cooperation between healthcare institutions and professional organizations is advised to establish and preserve a comprehensive database of ASP resources. These efforts should carry the potential to enhance ASP application in the healthcare system and reduce AMR.

Data availability

Data generated and/or analysed in the present study are available from the corresponding author on reasonable request.

Abbreviations

ASP:

Antimicrobial stewardship

AMR:

Antimicrobial resistance

DDD:

Defined daily dose

HCP:

Healthcare prescriber

IBM:

International Business Machines Corporation

ICU:

Intensive-care unit

SPSS:

Statistical Package for the Social Sciences

SD:

Standard deviation

References

  1. Abraham EP. The antibiotics. Compr Biochem. 1963;11(4):181–224.

    Article  Google Scholar 

  2. Marston HD, Dixon DM, Knisely JM, Palmore TN, Fauci AS. Antimicrobial resistance. JAMA - J Am Med Assoc. 2016;316(11):1193–204.

    Article  CAS  Google Scholar 

  3. World Health Organization. Global action plan on antimicrobial resistance [Internet]. 2016 [cited 2023 Mar 5]. p. 1–45. Available from: https://www.who.int/publications/i/item/9789241509763.

  4. CDC [Internet]. 2013 [cited 2024 Jan 10]. Antibiotic resistance threats in the United States. Available from: https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf.

  5. Antibiotic Resistance| What We Do| NCEZID| CDC [Internet]. 2022 [cited 2024 Jan 10]. Available from: https://www.cdc.gov/ncezid/what-we-do/2021-highlights/antibiotic-resistance.html.

  6. Saha SK, Kong DCM, Thursky K, Mazza D. Antimicrobial stewardship by Australian community pharmacists: Uptake, collaboration, challenges, and needs. J Am Pharm Assoc. 2021;61(2):158–168e7.

    Article  Google Scholar 

  7. Kpokiri EE, Ladva M, Dodoo CC, Orman E, Aku TA, Mensah A et al. Knowledge, awareness and practice with antimicrobial stewardship programmes among Healthcare Providers in a Ghanaian. Tert Hosp. 2022;1–11.

  8. Karanika S, Paudel S, Grigoras C, Kalbasi A, Mylonakis E. Systematic review and Meta-analysis of clinical and economic outcomes from the implementation of Hospital-based Antimicrobial Stewardship Programs. Antimicrob Agents Chemother. 2016;60(8):4840–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Alghamdi S, Atef-Shebl N, Aslanpour Z, Berrou I. Barriers to implementing antimicrobial stewardship programmes in three Saudi hospitals: evidence from a qualitative study. J Glob Antimicrob Resist. 2019;18:284–90.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Yeo CL, Wu JE, Chung GW, Chan DS, Chen HH, Hsu LY. Antimicrobial stewardship auditing of patients reviewed by infectious diseases physicians in a tertiary university hospital. Antimicrob Resist Infect Control. 2013;2(1):1–5.

    Article  Google Scholar 

  11. Parente DM, Morton J. Role of the Pharmacist in Antimicrobial Stewardship. Med Clin North Am. 2018;102(5):929–36.

    Article  PubMed  Google Scholar 

  12. Khasawneh RA, Ababneh MA, Al-Azzam SI. Antimicrobial stewardship programs: perceptions and practices among Jordanian healthcare practitioners. J Pharm Heal Serv Res. 2021;12(2):235–41.

    Article  Google Scholar 

  13. Doron S, Davidson LE. Antimicrobial stewardship. Mayo Clin Proc. 2011;86(11):1113–23.

  14. Abu Sbitan KIK. Knowledge, Attitudes and Practices towards Antimicrobial Stewardship among Healthcare Providers at Beit Jala Hospital. 2018.

  15. Baraka MA, Alsultan H, Alsalman T, Alaithan H, Islam MA, Alasseri AA. Health care providers’ perceptions regarding antimicrobial stewardship programs (AMS) implementation - facilitators and challenges: a cross-sectional study in the Eastern province of Saudi Arabia. Ann Clin Microbiol Antimicrob. 2019;18(1):1–10.

    Article  Google Scholar 

  16. Wang B, Li G, Jin F, Weng J, Peng Y, Dong S, et al. Effect of Weekly Antibiotic Round on Antibiotic Use in the neonatal Intensive Care Unit as Antibiotic Stewardship Strategy. Front Pediatr. 2020;8(December):1–7.

    Google Scholar 

  17. Kollef MH. Is antibiotic cycling the answer to preventing the emergence of bacterial resistance in the intensive care unit? Clin Infect Dis. 2006;43(SUPPL. 2).

  18. Gruson D, Hilbert G, Vargas F, Valentino R, Bui N, Pereyre S, et al. Strategy of antibiotic rotation: long-term effect on incidence and susceptibilities of Gram-negative bacilli responsible for ventilator-associated pneumonia. Crit Care Med. 2003;31(7):1908–14.

    Article  PubMed  Google Scholar 

  19. Papkou A, Hedge J, Kapel N, Young B, MacLean RC. Efflux pump activity potentiates the evolution of antibiotic resistance across S. Aureus isolates. Nat Commun. 2020;11(1).

  20. Roope LSJ, Smith RD, Pouwels KB, Buchanan J, Abel L, Eibich P et al. The challenge of antimicrobial resistance: what economics can contribute. Sci (80-). 2019;364(6435).

  21. Wong LH, Tay E, Heng ST, Guo H, Kwa ALH, Ng TM, et al. Hospital pharmacists and antimicrobial stewardship: a qualitative analysis. Antibiotics. 2021;10(12):1441.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Buckel WR, Hersh AL, Pavia AT, Jones PS, Owen-Smith AA, Stenehjem E. Antimicrobial stewardship knowledge, attitudes, and practices among health care professionals at small community hospitals. Hosp Pharm. 2016;51(2):149–57.

    Article  Google Scholar 

  23. Rusic D, Bozic J, Bukic J, Vilovic M, Tomicic M, Seselja Perisin A, et al. Antimicrobial Resistance: Physicians’ and pharmacists’ perspective. Microb Drug Resist. 2021;27(5):670–7.

    Article  CAS  PubMed  Google Scholar 

  24. Feng Z, Hayat K, Huang Z, Shi L, Li P, Xiang C, et al. Knowledge, attitude, and practices of community pharmacy staff toward antimicrobial stewardship programs: a cross-sectional study from northeastern China. Expert Rev Anti Infect Ther. 2021;19(4):529–36.

    Article  CAS  PubMed  Google Scholar 

  25. Saha SK, Kong DCM, Thursky K, Mazza D. Divergent and convergent attitudes and views of general practitioners and community pharmacists to collaboratively implement antimicrobial stewardship programs in Australia: a nationwide study. Antibiotics. 2021;10(1):1–18.

    Article  CAS  Google Scholar 

  26. AlKhamees OA, AlNemer KA, Bin Maneea MW, AlSugair FA, AlEnizi BH, Alharf AA. Top 10 most used drugs in the Kingdom of Saudi Arabia 2010–2015. Saudi Pharm J. 2018;26(2):211–6.

    Article  PubMed  Google Scholar 

  27. Saleh D, Abu-Farha R, Mukattash TL, Barakat M, Alefishat E. Views of community pharmacists on antimicrobial resistance and antimicrobial stewardship in Jordan: a qualitative study. Antibiotics. 2021;10(4):1–11.

    Article  Google Scholar 

  28. Saha SK, Kong DCM, Thursky K, Mazza D. A nationwide survey of Australian general practitioners on antimicrobial stewardship: awareness, uptake, collaboration with pharmacists and improvement strategies. Antibiotics. 2020;9(6):1–13.

    Article  Google Scholar 

  29. Sayegh N, Hallit S, Hallit R, Saleh N, Zeidan RK. Physicians’ attitudes on the implementation of an antimicrobial stewardship program in Lebanese hospitals. Pharm Pract (Granada). 2021;19(1):1–8.

    Article  Google Scholar 

  30. Hayat K, Rosenthal M, Gillani AH, Zhai P, Aziz MM, Ji W, et al. Perspective of Pakistani physicians towards hospital antimicrobial stewardship programs: a multisite exploratory qualitative study. Int J Environ Res Public Health. 2019;16(9):1–15.

    Article  Google Scholar 

  31. World Health Organization. Antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries: a WHO practical toolkit [Internet]. 2019 [cited 2023 Mar 5]. Available from: https://www.who.int/publications/i/item/9789241515481.

  32. Ji W, Hayat K, Ye D, McIver DJ, Yan K, Kadirhaz M, et al. Antimicrobial Stewardship Programs in Northwest China: a cross-sectional survey of perceptions, involvement, and Perceived barriers among Hospital pharmacists. Front Pharmacol. 2021;12(April):1–10.

    Google Scholar 

Download references

Acknowledgements

The authors wish to thank all the pharmacists and healthcare prescribers including physicians and dentists who participated in this study.

Funding

None reported.

Author information

Authors and Affiliations

  1. Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, 22110, Irbid, P.O. Box 3030, Jordan

    Anan S. Jarab, Tasneem O. AL-Alawneh, Osama Y. Alshogran, Shrouq Abu Heshmeh & Tareq L. Mukattash

  2. College of Pharmacy, AL Ain University, Abu Dhabi, United Arab Emirates

    Anan S. Jarab

  3. School of Pharmacy, Medical Biology Centre, Queen’s University Belfast, Northern Ireland, 97 Lisburn Road, BT9 7BL, Belfast, UK

    Yara A. Naser

  4. Department of Medical Sciences, College of Medicine and Health Science, Khalifa University of Science and Technology, 127788, Abu Dhabi, United Arab Emirates

    Eman Alefishat

  5. Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, 11942, Amman, Jordan

    Eman Alefishat

  6. Center for Biotechnology, Khalifa University of Science and Technology, 127788, Abu Dhabi, United Arab Emirates

    Eman Alefishat

Authors
  1. Anan S. Jarab
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tasneem O. AL-Alawneh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Osama Y. Alshogran
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shrouq Abu Heshmeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tareq L. Mukattash
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yara A. Naser
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eman Alefishat
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ASJ, TA, OA and EA contributed to conception and design of the study. ASJ and OA validated the study instrument. TA and SA collected the study data. OA, TLM, and YAN organized the database. OA, TLM and YAN performed the statistical analysis. ASJ, TA SA and EA wrote the first draft of the manuscript. ASJ, YAN and EA revised the manuscript. All authors read and approved the submitted version. All authors read and approved the final draft of the manuscript.

Corresponding author

Correspondence to Eman Alefishat.

Ethics declarations

Ethics approval and consent to participate

The study received ethical approval from the Institutional Review Board and the Deanship of Research at Jordan University of Science and Technology (Ref. No.17/139/2021). The participants were informed that completing the survey represents consent to participate in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jarab, A.S., AL-Alawneh, T., Alshogran, O.Y. et al. Knowledge and attitude of healthcare prescribers and pharmacists toward antimicrobial stewardship program and the barriers for its implementation. Antimicrob Resist Infect Control 13, 35 (2024). https://doi.org/10.1186/s13756-024-01382-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13756-024-01382-9

Keywords

Antimicrobial Resistance & Infection Control

ISSN: 2047-2994

Contact us