Factors contributing to excessive antimicrobial prescribing.

Several elements are known to influence the prescribing behaviors of clinicians; these elements may indirectly contribute to the current antibiotic resistance crisis. Lack of knowledge and time, as well as prescriber beliefs and attitudes, may be just as persuasive as test results when a clinician considers prescribing an antibiotic. In addition, patient expectations and demands may also sway some prescribers to write a prescription for an antibiotic that is unnecessary. Although culture and susceptibility testing methods are widely available in outpatient and institutional settings, they are often underused. As a result, broad-spectrum antibiotics frequently are prescribed inappropriately. In addition, prescribers may be unaware of local resistance patterns, and available antibiograms may not be updated appropriately or referenced by clinicians. Prescriber and patient education, as well as shifts in beliefs and attitudes, are required to help fight antibiotic resistance.