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Table 2 Physician related factors that contribute to excessive antibiotic use in the Western Pacific Region

From: Encouraging rational antibiotic use in childhood pneumonia: a focus on Vietnam and the Western Pacific Region

Factor identified Examples from the Western Pacific Region
Professional hierarchy • Junior physicians adopt the prescription habits of senior physicians without rigorous discussion or review of the evidence [86].
• In Vietnam, inappropriate antibiotic use is a particular problem in obstetrics, gynecology and surgery wards where professional hierarchy is most pronounced [58]
No consideration of “societal risk” • Doctors and patients often prefer newer and more expensive antibiotics, which are considered more “powerful” [62]
• Physicians provide antibiotics to help individual patients; potential societal risks are not considered [86];
• In the absence of functional microbiology services, physicians have limited information on local drug-resistance profiles and the impact of excessive antibiotic use;
Perceived patient/parent expectation • Doctors strive for patient satisfaction and if patients request antibiotics it is usually prescribed [70, 87]; In Korea, 73% of doctors prescribe antibiotics for a common cold if requested by parents [88]; In Malaysia, 67% of patients believe that antibiotics help for viral infections [61]
• Doctors have no time or motivation to explain the rationale for not using antibiotics
Fear of poor patient outcome or litigation • Fear of poor patient outcomes is often listed as a key motivation for the use of broad-spectrum antibiotics by doctors [58, 59, 89]
• Fear of litigation is not yet a major driver in the Western Pacific, but is likely to become a more prominent factor with increased development [90]
Inadequate microbiology services • Near universal use of empiric broad spectrum antibiotics is common in places with poor microbiology services [70, 87].
• In Vietnam, antibiotic use was reduced in hospitals with functional microbiology laboratories [58]
Financial incentives to use antibiotics • Doctors’ prescribing habits is influenced by personal income generated and incentives provided by pharmaceutical companies [70, 86, 87]. In China, as in many other Western Pacific countries, drug prescriptions supplement a doctor’s income [62].
• In South-Korea drug dispensing by health care workers was banned in 2000, resulting in major reductions in antibiotic use [62]