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Antibiotic prescriptions by medical interns in Hong Kong: influence of the hospital settings and prescription culture
  1. Tai Pong Lam1,
  2. Tak Hon Chan1,
  3. Kai Sing Sun1,
  4. Kwok Fai Lam2,3,
  5. Kit Wing Kwok1,
  6. Pak Leung Ho4
  1. 1 Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
  2. 2 Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, China
  3. 3 Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
  4. 4 Department of Microbiology, The University of Hong Kong, Hong Kong, China
  1. Correspondence to Tai Pong Lam, 3/F., Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong;tplam{at}


Background Inappropriate antibiotic prescribing practices predispose to resistance emergence. Despite the inclusion of the topic in medical school curricula worldwide, it is uncertain whether newly graduated medical interns have confidence in proper antibiotic prescription.

Objectives This study aimed to explore the antibiotic prescribing behaviours of the medical interns in Hong Kong and their barriers to appropriate antibiotic prescription.

Methods Two focus groups were conducted among medical interns with training experiences in different public hospitals. Their prescribing behaviours and barriers were further examined with a questionnaire survey just before completion of internship.

Results Focus group interviews identified a variety of hospital workplace cultures, including inappropriate empirical prescriptions and dosages, interns’ passive roles in prescribing antibiotics and varied guidelines between different departments. Defensive medicine and lack of clinical experience were other barriers encountered. The interns believed that the incorrect practice learnt would perpetuate in their minds and affect their future practice. The top barriers reported by the survey respondents were adaptation to prescription culture of different hospitals (93.5%), lack of experience in antibiotic prescription (88.3%), inadequate knowledge in the choice of antibiotics (85.7%) and compliance with the seniors’ instructions (80.6%). However, some focus group participants perceived weaker barriers in paediatric departments which provided close monitoring of antibiotic use.

Conclusions Inadequate knowledge and low confidence in antibiotic prescription led to the passive role of medical interns in antibiotic prescription, predisposing to future inappropriate practice. Inconsistent guidelines and prescription cultures between different hospitals and departments might further exacerbate their barriers.

  • Basic sciences
  • Microbiology
  • Health services administration & management
  • Rationing
  • Medical education & training
  • Qualitative research
  • Quality in healthcare

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  • Contributors TPL, PLH, KFL and KSS wrote the study protocol. TPL, KSS and THC coordinated the study. KSS and KWK conducted the focus groups. KSS, PLH, KWK and TPL drafted the questionnaire. THC, KSS and TPL did the qualitative analysis. KFL, THC and KSS conducted the statistical analysis. THC, TPL, KSS and PLH wrote the first draft. All authors participated in the drafting and approval of the final version of the manuscript.

  • Funding The work described in this paper was fully supported by Seed Fund for Basic Research, University Research Committee, The University of Hong Kong.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.