Barriers to and facilitators of adherence to evidence-based standard antimicrobial treatment guidelines among physicians in Ethiopia: a formative qualitative study

Why this matters for everyday health

Antibiotics save lives, but when they are used in the wrong way, bacteria learn to fight back. This article looks at why doctors in Ethiopia sometimes struggle to follow national treatment guides that are meant to keep antibiotic use safe and sensible. By listening directly to physicians across many public hospitals, the study shows what gets in the way of using these guides—and what could help—offering lessons that matter anywhere people depend on antibiotics to treat common infections.

How the study was carried out

The researchers visited 20 public hospitals in four regions of Ethiopia, from busy city centers to smaller rural facilities. They spoke in depth with 47 physicians, including general doctors and specialists in fields such as pediatrics, surgery, and intensive care. Instead of counting prescriptions, they asked open questions about how doctors actually make decisions when choosing antibiotics. Using a behavior framework that looks at a person’s ability, opportunity, and motivation, they sorted what they heard into themes that explain why doctors do—or do not—follow the country’s standard treatment guidelines.

When good advice is hard to use

Doctors agreed that standard treatment guidelines are important for safe, uniform care, but they often found them hard to use in real life. The printed books were described as bulky, poorly organized, and sometimes missing a clear way to quickly find needed information. Many felt the content was out of date or too shallow for complex cases, especially in areas like heart disease, skin problems, or emergency pregnancy care. Because updates came slowly and copies were scarce, physicians often turned instead to international references on their phones, or simply relied on their own experience—choices that could drift away from what the national guidance recommends.

Pressures from people, places, and the health system

The study revealed strong pressures around doctors that pull them away from recommended practice. Some senior clinicians preferred foreign textbooks or long-established habits and discouraged younger staff from using local guidelines. Many doctors reported they had never been formally trained to use Ethiopia’s treatment guide during medical school or on the job. Heavy patient loads left little time to search through a thick manual during short visits. In some hospitals, key antibiotics listed in the guide were not even available, making strict adherence impossible. Patients themselves sometimes arrived expecting powerful injections or broad antibiotics because of what they had received in private clinics, making it harder for public-sector doctors to choose more targeted, guideline-based treatments.

What helps doctors stay on track

Despite these obstacles, the physicians expressed strong personal commitment to using antibiotics wisely. They trusted guidelines that were clearly written by local experts and matched the medicines actually available in their hospitals. Regular review of cases, clinical audits, and feedback from hospital leaders helped make guideline use a normal part of daily work. Doctors also described how discussing difficult cases together, for example during morning rounds, helped align decisions with the guide. Many felt more attached to the recommendations when they or their colleagues had been involved in developing them, turning the document from an external rulebook into something they felt they owned.

Digital tools and training as a way forward

A striking message from the interviews was the demand for a simple mobile phone version of the treatment guide. Physicians wanted a searchable app that works offline, is updated regularly, and fits naturally into their fast-paced workflow. They also called for better training in how and why to use the guide, starting in medical school and continuing through regular refresher sessions. Stronger hospital support—such as making sure medicines are in stock, linking guideline use to professional development, and aligning rules across public and private clinics—was seen as essential to sustain improvements.

What this means for patients

For a lay reader, the takeaway is that even when good rules for antibiotic use exist on paper, doctors need the right tools, support, and conditions to put them into practice. In Ethiopian public hospitals, barriers such as outdated books, medicine shortages, heavy workloads, and conflicting private-sector habits can push care away from best practice. Yet the same physicians also show that with clear local guidance, digital access at the bedside, regular feedback, and strong teamwork, they can prescribe antibiotics more wisely. That combination offers a practical path to protect patients today while slowing the rise of drug-resistant infections for the future.

Citation: Boltena, M.T., Woldie, M., El-Khatib, Z. et al. Barriers to and facilitators of adherence to evidence-based standard antimicrobial treatment guidelines among physicians in Ethiopia: a formative qualitative study. Sci Rep 16, 11298 (2026). https://doi.org/10.1038/s41598-026-41472-9

Keywords: antimicrobial resistance, antibiotic prescribing, clinical guidelines, Ethiopia hospitals, digital health tools