Table 2.

Physician related factors that contribute to excessive antibiotic use in the Western Pacific Region

Factor identified	Examples from the Western Pacific Region
Professional hierarchy	• Junior physicians adopt the prescription habits of senior physicians without rigorous discussion or review of the evidence [86]. • In Vietnam, inappropriate antibiotic use is a particular problem in obstetrics, gynecology and surgery wards where professional hierarchy is most pronounced [58]
No consideration of “societal risk”	• Doctors and patients often prefer newer and more expensive antibiotics, which are considered more “powerful” [62] • Physicians provide antibiotics to help individual patients; potential societal risks are not considered [86]; • In the absence of functional microbiology services, physicians have limited information on local drug-resistance profiles and the impact of excessive antibiotic use;
Perceived patient/parent expectation	• Doctors strive for patient satisfaction and if patients request antibiotics it is usually prescribed [70, 87]; In Korea, 73% of doctors prescribe antibiotics for a common cold if requested by parents [88]; In Malaysia, 67% of patients believe that antibiotics help for viral infections [61] • Doctors have no time or motivation to explain the rationale for not using antibiotics
Fear of poor patient outcome or litigation	• Fear of poor patient outcomes is often listed as a key motivation for the use of broad-spectrum antibiotics by doctors [58, 59, 89] • Fear of litigation is not yet a major driver in the Western Pacific, but is likely to become a more prominent factor with increased development [90]
Inadequate microbiology services	• Near universal use of empiric broad spectrum antibiotics is common in places with poor microbiology services [70, 87]. • In Vietnam, antibiotic use was reduced in hospitals with functional microbiology laboratories [58]
Financial incentives to use antibiotics	• Doctors’ prescribing habits is influenced by personal income generated and incentives provided by pharmaceutical companies [70, 86, 87]. In China, as in many other Western Pacific countries, drug prescriptions supplement a doctor’s income [62]. • In South-Korea drug dispensing by health care workers was banned in 2000, resulting in major reductions in antibiotic use [62]