Barriers and Enablers to Optimal Antimicrobial Use in Respiratory Tract Infections

<b>Background/Objectives</b>: Antibiotic use for respiratory tract infections is often suboptimal and does not follow clinical guidelines. Inappropriate antibiotic use is a driver for antimicrobial resistance. Our aims were to identify antimicrobial prescribing guidelines used to aid decision-making, describe perceptions on guideline compliance, and explore barriers and enablers to optimal antimicrobial use in hospitalised patients with respiratory tract infections. <b>Methods</b>: Qualitative semi-structured interviews were conducted with antimicrobial stewardship pharmacists (<i>n</i> = 10) and respiratory (<i>n</i> = 5) and infectious diseases (<i>n</i> = 2) specialists from hospitals in New South Wales, Australia. Interviews were recorded, transcribed verbatim, and coded thematically. <b>Results</b>: Participants primarily used an online evidence-based national consensus guideline to inform antibiotic choices. These guidelines were perceived to be useful and simple to access but did not contain all relevant information and were deemed too verbose to be practical. Pharmacists and physicians had different perceptions on guideline compliance. Barriers to guideline compliance and optimal antibiotic use included inadequate diagnostics and staffing, patient treatment pressure, and lack of knowledge and ownership of the impact of prescribing decisions. A positive working relationship with the antimicrobial stewardship team, prescribing feedback, and increasing the availability of data and decision support tools were reported as enablers. <b>Conclusions</b>: National prescribing guidelines are available to guide decisions but adherence to their recommendations was variable. Insufficient access to useful diagnostics, resourcing, and knowledge may negatively impact antimicrobial prescribing. Education, feedback, and tools and data to aid decision-making may improve optimal antimicrobial use. Focusing on incorporating these enablers into future prescribing interventions will be vital for antimicrobial stewardship practices.