Fluoroquinolones (FQs) and extended-spectrum cephalosporins (ESCs) are associated with higher risk of Clostridioides difficile infection (CDI). Decreasing the unnecessary use of FQs and ESCs is a goal of antimicrobial stewardship. Understanding how prescribers perceive the risks and benefits of FQs and ESCs is needed.

We conducted interviews with clinicians from 4 hospitals. Interviews elicited respondent perceptions about the risk of ESCs, FQs, and CDI. Interviews were audio recorded, transcribed, and analyzed using a flexible coding approach.

Interviews were conducted with 64 respondents (38 physicians, 7 nurses, 6 advance practice providers, and 13 pharmacists). ESCs and FQs were perceived to have many benefits, including infrequent dosing, breadth of coverage, and greater patient adherence after hospital discharge. Prescribers stated that it was easy to make decisions about these drugs, so they were especially appealing to use in the context of time pressures. They described having difficulty discontinuing these drugs when prescribed by others due to inertia and fear. Prescribers were skeptical about targeting specific drugs as a stewardship approach and felt that the risk of a negative outcome from under treatment of a suspected bacterial infection was a higher priority than the prevention of CDI.

Prescribers in this study perceived many advantages to using ESCs and FQs, especially under conditions of time pressure and uncertainty. In making decisions about these drugs, prescribers balance risk and benefit, and they believed that the risk of CDI was acceptable in compared with the risk of undertreatment.

氟喹诺酮类 (FQ) 和超广谱头孢菌素 (ESC) 与艰难梭菌感染 (CDI) 的风险较高有关。减少对 FQ 和 ESC 的不必要使用是抗菌药物管理的目标。需要了解开处方者如何看待 FQ 和 ESC 的风险和益处。

我们采访了来自 4 家医院的临床医生。访谈引发了受访者对 ESC、FQ 和 CDI 风险的看法。使用灵活的编码方法对访谈进行录音、转录和分析。

对 64 名受访者（38 名医生、7 名护士、6 名高级执业提供者和 13 名药剂师）进行了访谈。ESC 和 FQ 被认为有许多好处，包括不经常给药、覆盖范围广以及出院后患者依从性更高。处方者表示，对这些药物做出决定很容易，因此在时间紧迫的情况下使用它们特别有吸引力。他们描述了由于惰性和恐惧，在别人开处方时难以停止使用这些药物。开药者对将特定药物作为一种管理方法持怀疑态度，并认为对疑似细菌感染的治疗不足导致负面结果的风险比预防 CDI 更重要。

本研究中的处方者认为使用 ESC 和 FQ 有许多优势，尤其是在时间压力和不确定性的情况下。在对这些药物做出决定时，处方者平衡了风险和收益，他们认为与治疗不足的风险相比，CDI 的风险是可以接受的。