Table 3 Antibiotic prescription practices: theme, subthemes, categories and exemplar quotations

Use of broad spectrum antibiotics

• Provides good cover

• Prophylactic use

R3: When you don’t know which microorganisms it is, you fire all the guns and it’s safe.

R4: We give broad spectrum to make sure that the patient does not acquire any hospital acquired infection.

Why bacteriology is not performed?

Patient perspective

• Affordability

R1: We live in a country with limited resources. We know that patient has, for example, respiratory or urinary tract infection, there might be known organisms and these antibiotics are effective so we will not tease a person with limited financial resources.

Hospitals perspective

• Limited resources

• Diagnosis based on clinical judgement

• Lack of inter department communication

• Unreliable laboratory test results

R4: Everything is not diagnosed on base of culture sensitivity tests there are many clinical signs e.g. pneumonia, GI problem we start the treatment and if problem is not solved we go for further investigations and we have limited resources so we cannot send cultures for every patient.

R10: Our bad scenario is that our labs are not up to date, you can conduct the same test from 3 different laboratories and all of the results will be different and culture tests reports take more than10 days so it is very time consuming.

Laboratory investigations performed

Before prescribing antibiotics

• Only complete blood count as base line investigation

• Culture tests were uncommon

R1: In government setup, we carry out basic investigations which indicate patient is having infection but what sort of infection what sort of organism he or she is having we cannot say anything about it.

R11: No trend of culture tests. We only do it if condition of patient is worse and no medicine is working against it.

Investigations adopted to check ‘antibiotic timeout’

• Improvement in apparent condition

• Check leucocyte count

• No specific investigations for ‘antibiotic timeout’

R5: Mainly improvement of symptoms, and then urine culture, blood tests showing improvement in total leucocyte count shows medicine is effective.

R3: In severe cases we have to give empiric treatment and it is recommended but after 72 h if you are asking about whether we check responses, we usually don’t.