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Impact of Antimicrobial Stewardship Training on Antibiotic Prescribing Practices among Doctors in Nigeria

Abstract

Antimicrobial resistance is an increasing public health concern in Nigeria, with inappropriate antibiotic prescribing contributing to the emergence and spread of resistant microorganisms. In healthcare facilities, inappropriate prescribing may involve unnecessary antibiotic use, inappropriate antibiotic selection, incorrect dosage, prolonged treatment duration, unnecessary combination therapy, and failure to follow evidence-based antimicrobial treatment guidelines. Doctors play a central role in antibiotic prescribing and therefore require adequate knowledge and skills to make appropriate antimicrobial treatment decisions. Antimicrobial stewardship training provides doctors with evidence-based information and practical skills for appropriate antibiotic selection, dosage, duration, de-escalation, antimicrobial susceptibility interpretation, and adherence to prescribing guidelines. Strengthening doctors' capacity through antimicrobial stewardship training may improve antibiotic prescribing practices and contribute to efforts to control antimicrobial resistance. Against this background, this study investigates the impact of antimicrobial stewardship training on antibiotic prescribing practices among doctors in Nigeria. The study will be anchored on Social Cognitive Theory, the Theory of Planned Behavior, and the Donabedian Model of Healthcare Quality. Social Cognitive Theory emphasizes knowledge, self-efficacy, observational learning, feedback, and environmental influences in shaping doctors' prescribing behaviour. The Theory of Planned Behavior explains how doctors' attitudes toward antimicrobial stewardship, perceived professional norms, perceived behavioural control, and behavioural intentions may influence antibiotic prescribing decisions. The Donabedian Model explains how healthcare structures, processes, and outcomes interact to influence healthcare quality, with antimicrobial stewardship training representing an important quality-improvement intervention and antibiotic prescribing practices representing a measurable care-process indicator. Collectively, these theoretical perspectives provide a suitable framework for explaining how antimicrobial stewardship training may influence antibiotic prescribing practices among doctors in Nigeria. The study will adopt a quantitative quasi-experimental research design. The study population will comprise medical doctors involved in antibiotic prescribing in selected public and private hospitals across Nigeria. A multistage sampling technique will be used to select states, local government areas, hospitals, clinical departments, and eligible doctors. Antimicrobial stewardship training will be measured using indicators such as exposure to structured training programmes, training frequency, training duration, content coverage, participation in practical antimicrobial stewardship activities, knowledge assessment before and after training, use of antimicrobial prescribing guidelines, training on antibiotic selection, dosage and duration, antimicrobial susceptibility interpretation, de-escalation, antibiotic review, and participation in stewardship activities. Antibiotic prescribing practices will be assessed using indicators such as appropriateness of antibiotic indication, antibiotic selection, dosage, route of administration, treatment duration, documentation of indication, consideration of microbiological results where available, de-escalation when appropriate, avoidance of unnecessary antibiotic combinations, adherence to hospital antimicrobial guidelines, and prescribing of antibiotics only when clinically indicated. Data will be collected using structured questionnaires, validated knowledge assessment tools, antibiotic prescription records, patient medical records, pharmacy records, laboratory reports, and antimicrobial stewardship documentation. Prescribing practices will be assessed before and after the training intervention. Descriptive statistics will be used to summarize doctors' demographic and professional characteristics, training exposure, antimicrobial stewardship knowledge, and prescribing patterns. Inferential statistical techniques, including paired sample tests, chi-square tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of antimicrobial stewardship training on antibiotic prescribing practices. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that antimicrobial stewardship training has a significant positive impact on antibiotic prescribing practices among doctors in Nigeria. Doctors exposed to structured antimicrobial stewardship training are expected to demonstrate improved adherence to evidence-based antibiotic prescribing guidelines, more appropriate antibiotic selection, accurate dosing, appropriate treatment duration, improved documentation, and greater use of microbiological information where available. Training may improve doctors' knowledge and confidence in making antimicrobial treatment decisions while encouraging regular review and de-escalation of antibiotic therapy when clinically appropriate. However, heavy clinical workloads, limited access to microbiological testing, inadequate availability of antimicrobial guidelines, medicine shortages, limited stewardship personnel, entrenched prescribing habits, and insufficient institutional support may reduce the effectiveness of training. The study therefore expects regular, practical, evidence-based, and institutionally supported antimicrobial stewardship training to contribute significantly to improved antibiotic prescribing practices among doctors in Nigeria. The study is expected to contribute to the literature on antimicrobial stewardship training, antibiotic prescribing practices, antimicrobial resistance, rational antibiotic use, clinical practice, hospital pharmacy, infection prevention, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention, medical schools, teaching hospitals, state ministries of health, hospital management, antimicrobial stewardship committees, medical professional organizations, pharmacists, microbiologists, development partners, and policymakers regarding strategies for improving antibiotic use. The study will also provide evidence-based recommendations for integrating antimicrobial stewardship training into continuing professional development programmes, strengthening hospital antimicrobial stewardship committees, improving access to prescribing guidelines and microbiological services, conducting regular prescribing assessments, and developing sustainable interventions to promote appropriate antibiotic prescribing and reduce antimicrobial resistance across Nigerian healthcare facilities.

Keywords: Antimicrobial stewardship training, antibiotic prescribing practices, doctors, antimicrobial resistance, rational antibiotic use, antibiotic stewardship, prescribing guidelines, infection prevention, hospital healthcare, Nigeria, public health.