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Impact of Antibiotic Resistance Education on Antibiotic Prescription Practices among Healthcare Professionals in Nigeria

Abstract

Antibiotic resistance has become a major public health concern because the inappropriate use and prescription of antibiotics contribute to the emergence and spread of resistant microorganisms, thereby reducing the effectiveness of available treatments and increasing the risk of treatment failure, prolonged illness, complications, healthcare costs, and preventable deaths. Healthcare professionals, particularly those involved in prescribing antibiotics, play a critical role in addressing antibiotic resistance because their prescription decisions directly influence the selection and use of antimicrobial medicines. Antibiotic resistance education provides healthcare professionals with knowledge and practical skills relating to the causes and consequences of antibiotic resistance, appropriate indications for antibiotic therapy, antimicrobial selection, dosage, route, duration of treatment, microbiological testing, de-escalation, avoidance of unnecessary antibiotic prescriptions, and adherence to antimicrobial stewardship guidelines. Antibiotic prescription practices refer to the behaviours and decisions involved in prescribing antibiotics appropriately, including prescribing antibiotics only when clinically indicated, selecting appropriate agents, determining correct dosage and duration, considering microbiological evidence where available, reviewing treatment, and avoiding unnecessary or inappropriate prescriptions. In Nigeria, inappropriate antibiotic prescribing may be influenced by limited awareness of antimicrobial resistance, empirical prescribing, inadequate diagnostic capacity, patient expectations, workload pressures, limited access to treatment guidelines, pharmaceutical influences, and weak antimicrobial stewardship systems. Effective antibiotic resistance education may improve healthcare professionals' knowledge, clinical decision-making, and adherence to appropriate antibiotic prescription practices. Against this background, this study investigates the impact of antibiotic resistance education on antibiotic prescription practices among healthcare professionals in Nigeria. The study is anchored on Social Cognitive Theory, the Theory of Planned Behaviour, and the Health Belief Model. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, behavioural capabilities, social influences, and environmental conditions in shaping healthcare professionals' prescribing behaviour. The Theory of Planned Behaviour explains how attitudes, subjective norms, perceived behavioural control, and behavioural intentions influence professional decision-making and prescribing practices. The Health Belief Model explains how perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action may influence healthcare professionals' recognition of the consequences of antibiotic resistance and their adoption of appropriate prescribing practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how antibiotic resistance education may influence antibiotic prescription practices among healthcare professionals in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from healthcare professionals involved in antibiotic prescribing in selected public and private healthcare facilities in Nigeria using a structured self-administered questionnaire, antibiotic resistance knowledge assessment, and an antibiotic prescription practice assessment tool. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, departments, and eligible healthcare professionals. Where feasible, selected healthcare facilities or professional groups will be assigned to intervention and comparison groups. Healthcare professionals in the intervention group will receive structured antibiotic resistance education covering the causes and consequences of antibiotic resistance, appropriate indications for antibiotic therapy, antibiotic selection, dosage, route, duration, microbiological testing, de-escalation, treatment review, avoidance of unnecessary antibiotic prescriptions, and antimicrobial stewardship principles. Antibiotic prescription practices will be assessed using indicators such as appropriate clinical indication, selection of antibiotic, dosage, route, treatment duration, consideration of microbiological evidence where available, documentation, review of therapy, de-escalation where appropriate, and adherence to relevant antibiotic treatment and antimicrobial stewardship guidelines. Where feasible, prescription records, patient treatment charts, or electronic prescribing records will be reviewed to complement self-reported information and improve measurement accuracy. Descriptive statistics will be used to summarize healthcare professionals' sociodemographic and professional characteristics, antibiotic resistance knowledge, exposure to education, and prescription practices. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the impact of antibiotic resistance education on antibiotic prescription practices. Where appropriate, pre-intervention and post-intervention prescription indicators will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that antibiotic resistance education has a significant positive impact on antibiotic prescription practices among healthcare professionals in Nigeria. Healthcare professionals exposed to structured antibiotic resistance education are expected to demonstrate improved knowledge of antimicrobial resistance and greater adherence to appropriate antibiotic prescribing principles. Education may improve prescribing decisions regarding clinical indications, antibiotic selection, dosage, duration, route of administration, microbiological testing, treatment review, and de-escalation. It may also reduce unnecessary antibiotic prescriptions and improve compliance with evidence-based antimicrobial stewardship guidelines. However, education alone may not guarantee sustained improvements in prescribing practices because healthcare professionals may continue to face barriers such as limited diagnostic and microbiology services, medicine shortages, patient pressure for antibiotics, heavy workloads, inadequate access to updated treatment guidelines, limited antimicrobial stewardship support, and weak prescription monitoring systems. Consequently, antibiotic resistance education is expected to be most effective when supported by functional antimicrobial stewardship programmes, accessible diagnostic services, evidence-based prescribing guidelines, prescription audits, regular feedback, and institutional support for rational antibiotic use. The study is expected to contribute to the literature on antimicrobial resistance, antibiotic prescribing, antimicrobial stewardship, healthcare professional education, patient safety, infection prevention and control, health education, and public health in Nigeria by providing empirical evidence on the impact of antibiotic resistance education on antibiotic prescription practices among healthcare professionals. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention, National Agency for Food and Drug Administration and Control, National Primary Health Care Development Agency, state ministries of health, hospital management authorities, medical and pharmacy professional bodies, antimicrobial stewardship committees, public health practitioners, development partners, and policymakers regarding strategies for promoting rational antibiotic prescribing. The study will also provide evidence-based recommendations for strengthening antibiotic resistance education, integrating antimicrobial stewardship into continuing professional development, improving access to diagnostic services, strengthening prescription monitoring and audit systems, expanding antimicrobial stewardship programmes, improving adherence to evidence-based treatment guidelines, and promoting responsible antibiotic prescribing across healthcare facilities in Nigeria.

Keywords: Antibiotic resistance education, antibiotic prescription practices, healthcare professionals, antimicrobial resistance, antimicrobial stewardship, antibiotic prescribing, rational antibiotic use, infection prevention and control, healthcare education, patient safety, health education, public health, Nigeria.