The knowledge, attitudes and practices of doctors regarding antibiotic resistance at a tertiary care institution in the Caribbean

Alison Nicholson, Ingrid Tennant, Livingston White, Camille-Ann Thoms-Rodriguez, Loraine Cook, Stephen Johnson, Tamara Thompson, Jasper Barnett, Lundie Richards

Antibiotic resistance (ABR) is a serious threat that requires coordinated global intervention to prevent its spread. There is limited data from the English-speaking Caribbean. As part of a national programme to address antibiotic resistance in Jamaica, a survey of the knowledge, attitudes and antibiotic prescribing practices of Jamaican physicians was conducted using a 32-item self-administered questionnaire. Of the eight hundred physicians targeted, 87% responded. The majority thought the problem of resistance very important globally (82%), less nationally (73%) and even less (53%) in personal practices. Hospital physicians were more likely to consider antibiotic resistance important in their practice compared to those in outpatient practice or both (p < 0.001). Composite knowledge scores were generated and considered good if scored > 80%, average if 60-79% and poor if < 60%. Most had good knowledge of factors preventing resistance (83%) and resistance inducing potential of specific antibiotics (59%), but only average knowledge of factors contributing to resistance (57%). Knowledge of preventative factors was highest in females (p = 0.004), those with postgraduate training (p = 0.001) and those > four years post graduation (p = 0.03). Empiric therapy was often directed by international guidelines and cultures were not routinely done. Limited laboratory and human resources were identified as challenges. Physicians in this study were aware of the problem of ABR, but downplayed its significance nationally and personally. These results will guide a national antibiotic stewardship programme.