คำอธิบายในการตัดสินใจเลือกสั่งใช้ meropenem ของแพทย์ กรณีศึกษาในโรงพยาบาลแห่งหนึ่งในภาคใต้

Abstract

This research aimed to study the explanation of the physicians regarding their decision to prescribe meropenem based on their perspectives and experiences. The research was a qualitative study collecting the data by in-depth interview. The participants were 9 physicians who prescribed meropenem for at least 10 times a year. Data were analyzed using content analysis. The results are as follows Physicians made decision to prescribe meropenem based on the following 5 reasons 1) high severity of the disease or patients' symptoms including meningitis, septic shock, sepsis with multiple organ failure, and maternal sepsis 2) expectation of better treatment outcomes when patients' symptoms did not improved after treatment with other antibiotics in empirical treatment and specific treatment 3) limitations to use other medications secondary to patient and medication factors, 4) Loss of confidence in microbiology laboratory process and report e.g. specimen collection process, gram stain reading, susceptibility results 5) Lack of experience of using meropenem sparing antibiotics. Additional factor that force the physicians to prolong use of meropenem was the delay of microbiology laboratory report. Even though some of their decision sound justified, those decision were evaluated as "not appropriate" per the hospital criteria for meropenem indication. The physicians chose to prescribe meropenem dose of 1 g every 8 hour for both severe and non-severe infection cases. Except in meningitis that meropenem was prescribed 2 g q 8 hour. Most physicians notified that they did not prescribe loading dose. Duration of treatment mentioned by the physicians for meningitis and other infections were 14-21 and 7-14 days, respectively. In conclusion, physician made decision to prescribe meropenem based on the fear of patient poor outcome. They used patients' clinical data and microbiological data as the key information to make decision. We suggested theses intervention to be done by hospital executive administrators to promote rational use of meropenem in our hospital 1) modified criteria for meropenem's indication to make it more explicit, evidence based. Additionally, criteria should be guided by local antimicrobial susceptibility data. 2) acquire the automated antimicrobial susceptibility testing to expedite and improve microbiological laboratory process and report. 3) support the training regarding rational use of antimicrobial therapy for related health careprofessionals.