Table 5 Selection of participant quotes surrounding their antimicrobial guidelines, clinical microbiology services and some problems associated with information provided by these sources
No. | Quote | |
|---|---|---|
Reliance on guidelines | ||
1 | “Does that really change your management? With the majority of cases it hasn’t. So you strap them on the standard hospital protocol for CAP/infective exacerbation and you tend to just carry it on” | On-rotation, acute medicine 1 |
2 | “Well because we’re almost held down now by [antibiotic app guidelines] or whatever your Trust uses, so you end up, if you haven’t done something by that choice you will go, or normally a pharmacist will go, why haven’t you done that?” | On-rotation, acute medicine 2 |
3 | “I do find antibiotic guidelines very helpful, and actually in the last couple of trusts I’ve worked in, they’ve been so comprehensive that I’ve not really used any other sources at all” | Specialist registrar, geriatrics |
4 | “I think in terms of decision making I have to say I don’t keep up to date with the antibiotic formula because I look it up if I need it” | Specialist registrar, cardiology |
5 | “Quite often on a post-take ward round say, why are we giving this, has anyone checked the policy, is this in line with policy because I don’t think it is?” | Consultant, respiratory |
Reliance on microbiology | ||
1 | “If I think it clearly isn’t within guideline or I’m not sure, it doesn’t easily fit into the guideline I’m going to say, speak to micro” | Consultant, respiratory |
2 | “I think when you call the microbiologist the fact that you’ve made the call has already told them that you’re concerned so you’re almost saying, I want a change, give me further guidance” | Consultant, geriatrics |
3 | “If the patient has a lot of allergies for example, then that often makes it more difficult and I often end up speaking to micro if that’s the case” | On-rotation, respiratory |
Problems with guidelines and microbiology | ||
1 | “I mean I’m a complete pedant I hate this idea that microbiologists have just given antibiotics broad spectrum for sepsis of unknown origin because that’s not what I’m about as a physician” | Consultant, gastroenterology |
2 | “I think the difficult thing which sometimes arises that microbiology are often the more conservative end of the antibiotic spectrum and say, OK, you’ve had your course, stop and I may agree with that as a registrar. But the problem is that actually suggesting for me to do it is the wrong person because it’s my decision once I’ve seen the patient on the ward round, but once you’ve got a consultant [microbilogist] that’s come and ratified the decision then that becomes their decision” | Specialist registrar, cardiology |
3 | “They tend to give more of a patient specific approach but the difficulty in that is that they haven’t seen the patient. So they’re sort of just giving you advice over the telephone” | On-rotation, gastroenterology |
4 | “A lot of the time is I would maybe rather wait and speak to someone whose opinion and knowledge seems more valuable, where sometimes maybe the opinion that you get out of hours [from junior microbiologists] is someone who is just answering a question to get it dealt with, and so it’s too broad, it’s too much” | Consultant, respiratory |
5 | “Well it’s not patient specific [local guidelines] so it’s quite generalised and it won’t always have all the information about the patient” | On-rotation, respiratory |
6 | “I always think that people and especially microbiologists recommend changing antibiotics far too soon. You ring up a micro registrar who just says, oh immediately I want to change from Augmentin to Tazocin. Well, why?” | Consultant, gastroenterology |