Physicians’ attitudes on the implementation of an antimicrobial stewardship program in Lebanese hospitals

Main Article Content


Antimicrobial Stewardship, Anti-Bacterial Agents, Drug Resistance, Bacterial, Anti-Infective Agents, Hospitals, Physicians, Attitude of Health Personnel, Health Plan Implementation, Cross-Sectional Studies, Lebanon


Background: Misuse of antibiotics and antimicrobial resistance are global concerns. Antibiotic stewardship programs (ASP) are advocated to reduce pathogens resistance by ensuring appropriate antimicrobial use. Several factors affect the implementation of ASPs in hospitals. The size and types of care provided, as well as the complexity of antibiotic prescription, are all issues that are considered in designing an effective hospital-based program.

Objectives: To examine physicians’ attitude on implementation of an antimicrobial stewardship program in Lebanese hospitals.

Methods: A descriptive cross-sectional survey was carried out using an online questionnaire. Survey items assessed ASP implementations, physicians’ attitudes, usefulness of the tools, and barriers of implementation. The questionnaire was based on the Center for Disease Control core-elements.

Results: 158 physicians completed the survey with a response rate of 4%. Our results showed that the majority (66%) of physicians were familiar with the ASP concept. Most respondents reported a lack of regular educational programs (41%), as well as a lack of support from the medical staff (76%). This study demonstrated positive attitudes and support for ASP implementation. However, ASPs were reported as affecting physicians’ autonomy by 34 % of the participants. Antibiotic rounds and prospective audit and feedback were rated as most useful interaction methods with the ASPs. A minimal support of the Ministry Of Public Health, as well as the absence of regulation and of national guidelines, were reported as barriers to ASPs. The shortage of Infectious Disease physicians was seen as a barrier by half of the respondents.

Conclusions: Physicians are supportive of ASP, with preference for interventions that provide information and education rather than restrictive ones. Additional research is needed on a larger sample of physicians.


Download data is not yet available.
Abstract 826 | pdf Downloads 511 online appendix Downloads 0


1. Özgenç O. Methodology in improving antibiotic implementation policies. World J Methodol. 2016;6(2):143-153.
2. Center for Disease Dynamics, Economics & Policy. Policies to Address antibiotic resistance in low- and middle-income countries national and international action on antimicrobial resistance. (accessed Oct 20, 2020).
3. Leung E, Weil DE, Raviglione M, Nakatani H; World Health Organization World Health Day Antimicrobial Resistance Technical Working Group. The WHO policy package to combat antimicrobial resistance. Bull World Health Organ. 2011;89(5):390-392.
4. Jasovský D, Littmann J, Zorzet A, Cars O. Antimicrobial resistance-a threat to the world's sustainable development. Ups J Med Sci. 2016;121(3):159-164.
5. WHO. Antibiotic resistance. (accessed Oct 3, 2018)
6. Moghnieh R. Antimicrobial resistance surveillance in Lebanon, a bird eye view. (accessed Oct 20, 2020).
7. Chamoun K, Farah M, Araj G, et al. Surveillance of antimicrobial resistance in Lebanese hospitals: retrospective nationwide compiled data. Int J Infect Dis. 2016;46:64-70.
8. Araj G, Zaatari G. Antimicrobial susceptibility profiles of bacterial isolates at the American university of Beirut Medical center, July 2016-June 2017. (accessed Oct 20, 2020).
9. Cheaito L, Azizi S, Saleh N, Salameh P. Assessment of self-medication in population buying antibiotics in pharmacies: a pilot study from Beirut and its suburbs. Int J Public Health. 2014;59(2):319-327.
10. Farah R, Lahoud N, Salameh P, Saleh N. Antibiotic dispensation by Lebanese pharmacists: a comparison of higher and lower socio-economic levels. J Infect Public Health. 2015;8(1):37-46.
11. Salameh P, Sacre H, Hallit S, Hajj A. Antibiotic resistance in Lebanon. (accessed Oct 20, 2020).
12. CDC. Core elements of hospital antibiotic stewardship programs. (accessed Oct 20, 2020).
13. Araj GF. Clinical Microbiology Laboratory & Antimicrobial Stewardship. (accessed Oct 20, 2020).
14. Chamieh A, Nawfal TD, Ballouz T, et al. Control and Elimination of Extensively Drug-Resistant Acinetobacter baumanii in an Intensive Care Unit. Emerg Infect Dis. 2019;25(10):1928-1931.
15. Abou Ghannam H. Creation of antibiotic stewardship unit within a healthcare system. Master Thesis. Lebanese University Faculty of Sciences. 2014.
16. Cunningham CT, Quan H, Hemmelgarn B, et al. Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol. 2015;15:32.
17. Martins Y, Lederman RI, Lowenstein CL, et al. Increasing response rates from physicians in oncology research: a structured literature review and data from a recent physician survey. Br J Cancer. 2012;106(6):1021-1026.
18. Abdulaziz K, Brehaut J, Taljaard M, et al. National survey of physicians to determine the effect of unconditional incentives on response rates of physician postal surveys. BMJ Open. 2015;5(2):e007166.
19. Steinberg M, Dresser LD, Daneman N, et al. A National Survey of Critical Care Physicians' Knowledge, Attitudes, and Perceptions of Antimicrobial Stewardship Programs. J Intensive Care Med. 2016;31(1):61-65.
20. Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51-e77.
21. Thriemer K, Katuala Y, Batoko B, et al. Antibiotic prescribing in DR Congo: a knowledge, attitude and practice survey among medical doctors and students. PLoS One. 2013;8(2):e55495.
22. García C, Llamocca LP, García K, et al. Knowledge, attitudes and practice survey about antimicrobial resistance and prescribing among physicians in a hospital setting in Lima, Peru. BMC Clin Pharmacol. 2011;11:18.
23. Pulcini C, Williams F, Molinari N, Davey P, Nathwani D. Junior doctors' knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland. Clin Microbiol Infect. 2011;17(1):80-87.
24. Buckel WR, Hersh AL, Pavia AT, Jones PS, Owen-Smith AA, Stenehjem E. Antimicrobial stewardship knowledge, attitudes, and practices among health care professionals at small community hospitals. Hosp Pharm. 2016;51(2):149-157.
25. Cotta MO, Robertson MS, Tacey M, Attitudes towards antimicrobial stewardship: results from a large private hospital in Australia, Healthcare Infect. 2014;19(3):89-94.
26. Pollack LA, van Santen KL, Weiner LM, Dudeck MA, Edwards JR, Srinivasan A. Antibiotic Stewardship Programs in U.S. Acute Care Hospitals: Findings From the 2014 National Healthcare Safety Network Annual Hospital Survey. Clin Infect Dis. 2016;63(4):443-449.
27. Lim CJ, Kwong M, Stuart RL, et al. Antimicrobial stewardship in residential aged care facilities: need and readiness assessment. BMC Infect Dis. 2014;14:410.
28. Bannan A, Buono E, McLaws ML, Gottlieb T. A survey of medical staff attitudes to an antibiotic approval and stewardship programme. Intern Med J. 2009;39(10):662-668.
29. Flannery DD, Swami S, Chan S, Eppes S. Prescriber perceptions of a pediatric antimicrobial stewardship program. Clin Pediatr (Phila). 2014;53(8):747-750.
30. van Limburg M, Sinha B, Lo-Ten-Foe JR, van Gemert-Pijnen JE. Evaluation of early implementations of antibiotic stewardship program initiatives in nine Dutch hospitals. Antimicrob Resist Infect Control. 2014;3(1):33.
31. Alothman A, Algwizani A, Alsulaiman M, Alalwan A, Binsalih S, Bosaeed M. Knowledge and Attitude of Physicians Toward Prescribing Antibiotics and the Risk of Resistance in Two Reference Hospitals. Infect Dis (Auckl). 2016;9:33-38.
32. Alameddine M, Bou Karroum K, Hijazi MA. Upscaling the pharmacy profession in Lebanon: workforce distribution and key improvement opportunities. Hum Resour Health. 2019;17(1):47.
33. Patel SJ, Rosen E, Zaoutis T, Prasad P, Saiman L. Neonatologists' perceptions of antimicrobial resistance and stewardship in neonatal intensive care units. Infect Control Hosp Epidemiol. 2010;31(12):1298-1300.
34. Tegagn GT, Yadesa TM, Ahmed Y. Knowledge, Attitudes and practices of healthcare professionals towards antimicrobial stewardship and their predictors in fitche hospital. J Bioanal Biomed. 2017;9(2):91-97.

Most read articles by the same author(s)

1 2 > >>