Article Text

Eliciting views on antibiotic prescribing and resistance among hospital and outpatient care physicians in Berlin, Germany: results of a qualitative study
  1. Edward Velasco1,2,
  2. Antina Ziegelmann3,
  3. Tim Eckmanns1,
  4. Gérard Krause1
  1. 1Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
  2. 2Faculty of Medicine, Charité—University Hospital Berlin, Berlin, Germany
  3. 3Division for Communicable Diseases, AIDS, Prevention of Epidemics, Federal Ministry of Health, Berlin, Germany
  1. Correspondence to Edward Velasco; velascoe{at}


Objective To better understand physicians' views on factors of influence for the prescribing of antibiotics and on antibiotic resistance in the Berlin region, Germany.

Design Qualitative study with focus groups.

Setting Outpatient care and hospital care practice in the Berlin region, Germany.

Participants 7 General practitioners, two urologists, one paediatrician from outpatient care and eight internists, two paediatricians, two ear, nose and throat specialists and two urologists from hospital care.

Results Physicians showed differential interest in topics related to antibiotic prescribing and antibiotic resistance. Outpatient care physicians were interested in topics around their own prescribing, such as being able to diagnose and prescribe precisely, and topics about patient demand and non-compliance. Hospital care physicians were interested in hygiene challenges, limited consult time and multi-resistant pathogens.

Conclusions Physicians considered the development of resistance to be more in the domain of clinical treatment than that of the patient. Major challenges related to antibiotic resistance for this group of physicians are access to and clarity of treatment recommendations, implementation of hygienic measures, as well as increased outsourcing of laboratory services. Results raise questions about whether meeting physicians' expectations should be a focus when developing intervention that aims to influence antibiotic resistance in this and other areas of Germany.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • Data access All authors had full access to all the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • The authors assure that all authors included on this paper fulfil the criteria of authorship. In addition, we assure that there is no one else who fulfils the criteria but has not been included as an author.

  • To cite: Velasco E, Ziegelmann A, Eckmanns T, et al. Eliciting views on antibiotic prescribing and resistance among hospital and outpatient care physicians in Berlin, Germany: results of a qualitative study. BMJ Open 2012;2:e000398. doi:10.1136/bmjopen-2011-000398

  • Funding This research was funded by a departmental grant from the Federal Ministry of Health. The study sponsors had no role in the study design or in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was approved by the institutional commission for data protection of the Robert Koch Institute. All participants gave informed consent before taking part in focus group discussions.

  • Contributors EV completed all analysis and drafted the manuscript. AZ, TE and GK conceived of the study and obtained funding. All authors contributed to the study design, the carrying out of the study and provided critical feedback to the manuscript.

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

  • Data sharing statement No additional data available.