Prescribing under pressure: Institutional barriers to stewardship among clinicians of different specialties in Saudi Arabia

Objectives

To evaluate clinicians’ antibiotic stewardship knowledge, prescribing behaviors, and opinions and identify demographic and institutional factors influencing stewardship effectiveness.

Study design

Mixed-methods.

Methods

We used a validated questionnaire and focus group interviews to gather data from 116 clinicians. Qualitative analysis explored institutional and experiential barriers, whereas quantitative analysis examined associations between stewardship knowledge and clinician characteristics.

Results

Significant associations were found between stewardship knowledge and age (p = 0.0092), gender (p = 0.0045), and years of experience (p = 0.0460). Pediatricians demonstrated higher stewardship knowledge than family physicians (p = 0.0106). Focus group discussions revealed institutional barriers including time constraints, lack of monitoring mechanisms, and diagnostic uncertainty. One participant noted, “It's safer to prescribe antibiotics just in case, rather than risk a patient developing a severe infection.”

Conclusions

Clinicians face both personal and institutional challenges in applying stewardship principles. We need local standards to reduce multidrug resistance; thus, targeted continuing medical education, structured case-based training, public awareness campaigns, and improved access to rapid diagnostics may enhance the effectiveness of antimicrobial stewardship programs across specialties.