Key stakeholders’ perspectives on the underlying causes of antimicrobial resistance in Thailand.

Background Antimicrobial resistance (AMR) is a major problem worldwide. Antimicrobial stewardship (AMS) has the vital aim of ensuring optimal use of antimicrobial medicines to minimize AMR. New strategies are needed to reduce AMR. It is vital to ensure that key stakeholders are involved in the development of these strategies. This study aimed to examine key stakeholders’ perspectives on the underlying causes of AMR in Thailand. Materials and methods Semi-structured interviews were conducted with 15 key multidisciplinary clinicians, heads of department and healthcare administrators who were involved in AMS programs in a 1,000-bed university hospital in Bangkok Thailand. Qualitative content analysis was used to analyze the interview data. Results One of the key themes that emerged was lack of regulatory control resulting in widespread antibiotic availability and use both in health and agriculture in Thailand, including over-the-counter availability of antibiotics. This ease of accessibility combined with poor consumer knowledge was considered one of the most important contributors to the increasing prevalence of AMR. The development and implementation of more effective infection prevention and control strategies was identified as a priority, particularly in healthcare. Three major concerns related to the perception that many patients admitted to hospital already have AMR infections, that staff prescribing behaviors are not ideal, and that the lack of resources to develop and implement AMS programs is an important barrier to decreasing the overuse of antibiotics. Conclusions Participants recognized that AMR is a major problem in Thailand and in healthcare. There was agreement that what is required is better regulatory control of antibiotics and medical engagement in AMS.