Submission ID 131889
| Issue/Objective | In Bangladesh, intern physicians in public tertiary hospitals frequently initiate first-line antibiotics without institutional guidance, contributing to inappropriate antimicrobial use in resource-limited settings. However, evidence on institutional and behavioral determinants of prescribing practices among interns remains limited. This study assessed empirical antibiotic prescribing and its determinants in tertiary hospitals. |
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| Methodology/Approach | A multicentre cross-sectional survey was conducted from September 2025 to January 2026 among 384 intern physicians across 15 public tertiary hospitals in Bangladesh. A pre-tested structured questionnaire was administered in person and online to consenting participants. Data were collected on antibiotic prescribing practices, prescribing autonomy, timing of antibiotic initiation, and institutional and behavioral determinants, including access to hospital guidelines, senior physician influence, workload constraints, pharmacy stock availability, and clinical decision-making factors. Empirical antibiotic prescribing was defined as initiation of antibiotics without microbiological confirmation. Multivariable logistic regression was used to identify factors associated with empirical prescribing, adjusting for hospital type and clinical rotation. |
| Results | Although 90.6% of interns were aware of antimicrobial resistance, 72.4% initiated antibiotics based solely on clinical diagnosis, and only 9.2% awaited culture results. Independent prescribing was reported by 84% of interns, with 96.2% using beta-lactams empirically. Commonly cited reasons for empirical initiation were fear of treatment delays (54%), severe or worsening symptoms (48.1%), guidance from senior staff (28%), and hospital traditions (26.7%). Pharmacy stock influenced antibiotic selection in 51% of cases. Time constraints due to heavy patient load were reported by 52.4% of interns, and hierarchical influence from senior physicians by 49.1%. Absence of hospital antibiotic guidelines significantly increased the odds of empirical prescribing (aOR 1.67; 95% CI 1.04-2.70). |
| Discussion/Conclusion | Empirical antibiotic prescribing is highly prevalent among intern physicians in Bangladesh despite strong awareness of antimicrobial resistance. These findings highlight critical structural and behavioral drivers, including limited access to institutional guidelines, hierarchical prescribing culture, workload pressures, and pharmacy-related constraints. Strengthening antimicrobial stewardship programs, ensuring guideline availability, and improving structured supervision of interns are essential to promote rational antibiotic use and enhance health system accountability in resource-limited tertiary care settings. |
| Presenters and Affiliations | Rakkan Afsara International Centre for Diarrhoeal Disease Research, Bangladesh Ishtiaque Hossain Ayon North South University Sanjida Khanom Chowa Sher-E-Bangla Medical College Al-Nuhin Hridoy Khulna Medical College Sumaia Shirin Humaira Faridpur Medical College Nishat Hasan Emon Netrokona Medical College |
