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

The study used qualitative interviews with 47 physicians in 20 Ethiopian public hospitals to identify why adherence to evidence-based antimicrobial treatment guidelines is inconsistent; major barriers included bulky or outdated guidelines, limited training and confidence, resistance from senior clinicians, restricted access to medicines, delayed guideline dissemination, heavy workloads, and variable private-sector practices, while facilitators included peer collaboration, clinical audits, trust in local guidance, and professional motivation, leading participants to recommend updating and digitalising guidelines (e.g., a smartphone app), improving training and institutional support, and strengthening policy implementation to enhance rational antimicrobial prescribing.