Hospital politics risks emergence of antibiotic resistant ‘superbugs’

Hospital politics and a power imbalance between doctors and pharmacists may be a key reason why antibiotics continue to be chronically misused in Australian hospitals, new research suggests.

A UNSW study has found hospital pharmacists are struggling with doctors for the authority to manage the risks of antibiotic misuse, which include the emergence of drug resistant ‘superbugs’ and the reduced viability of standard medical procedures.

Thousands of Australians die every year due to bacterial infections, and this could dramatically escalate as more antibiotics become ineffective in treating these superbugs.

Approximately 30% of antibiotic prescriptions in hospitals are inappropriate, meaning the choice, dose or duration of antibiotic is incorrect or that antibiotics are not needed, recent Australia-wide data from the National Antimicrobial Prescribing Survey revealed.

While most pharmacists knew that judicious use of the limited number of antibiotics was key to heading off the superbug emergence, they struggled to influence change in hospital settings, said the study’s leader professor of sociology Alex Broom, from the Practical Justice Initiative in UNSW’s Faculty of Arts and Social Sciences.

Based on in-depth interviews with 19 pharmacists in Queensland, the study explores pharmacists’ perceptions, experiences and capacity to participate in decisions about antibiotic use.

The pharmacists told the researchers their recommendations were often ignored within the hospital environment, and that doctors often failed to adhere to antibiotic policies.

“Pharmacists may know that an antibiotic prescription is inappropriate in dosage, type or mode of delivery, yet they are restricted in their influence to change the prescription due to power dynamics, social hierarchies and inter-professional relations in hospitals,” Professor Broom said.

“Junior doctors often appreciate pharmacy support in prescribing antibiotics as there is often uncertainty and ambiguity in diagnosis and appropriate treatment. However, without senior doctor buy-in, the impact on prescribing decisions has been extremely limited.”

One attempt to solve the problem has been the appointment of antibiotic pharmacy specialists in hospitals to enforce best practice guidelines, but their numbers remain low.

Many pharmacists also said getting doctors to listen to their advice was much easier when the pharmacists were directly involved at the bedside, early in the patient’s treatment.

“There are always real dilemmas when it comes to antibiotics – between the patient’s immediate health and the long-term risks to the broader community. But better and more judicious use of antibiotics protects both. It protects patients from unnecessary or incorrect medications, and the broader community from the proliferation of resistant organisms,” Professor Broom said.

The study is published in the journal Social Science and Medicine. It is part of a broader research program led by UNSW and funded by the Australian Research Council, looking at the social underpinnings of antibiotic misuse in Australian society. The program involves interviews with doctors, pharmacists, nurses, patients and families in Queensland and New South Wales to understand the underlying reasons for the ongoing misuse of antibiotics.