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Table 2 Sub-categories within students’ focus

From: Investigating pharmacy students’ therapeutic decision-making with respect to antimicrobial stewardship cases

Categories

Reflective quotes

Category 1: Patient-centered factors

2.1. “One strategy that I would be thinking for this patient is that, since she has an allergy to penicillin and it says it is unknown so we need to go and talk to the patient, take a history of allergy. It is very important to know about the time, because if the allergy was more than 10 years ago, then if we would ask, assess and re-challenge, we will most likely, more than 95% of patients will not have allergies to penicillin” – Participant 5

2.2. “I will convert from intravenous to oral once the patient is stable. Pyelonephritis is kind of a severe case, so I will have to check that the patient is totally stable and all the vitals are totally stable. And if I can minimize the hospital stay, it will be much better to convert from IV to oral to decrease any probability of getting an infection during the hospital stay” – Participant 13

2.3. “As for pharmacokinetic/pharmacodynamics principles, we will need to calculate the dose based on his weight and assess his kidney function in order to make any dose adjustments for his renal clearance” – Participant 13

Category 2: Drug-bug related factors

2.4. “We need to tailor our empiric therapy to the institutional resistant patterns and national antibiogram” – Participant 2

2.5. “We have the cultures, the sensitivities, we have the bacteria, meropenem is too broad and it covers Pseudomonas, and our bacteria appears to be a gram negative bacteria which is E.coli so we need to narrow down our choices” – Participant 4

Category 3: AMS interventions

2.6. “What I would do is that, if there is no preauthorization for a specific antipseudomonal beta-lactam, then I would suggest to include in the system that physicians cannot order such antibiotics for more than 2 days, or for a specific duration, without getting an approval from the responsible ID team” – Participant 3

2.7. “A healthcare team should review the patient's records and then decide if the antibiotic should be de-escalated to a narrow spectrum antibiotic” – Participant 1

Category 4: Pharmacist’s role

2.8. “So with vancomycin, we have to have therapeutic drug monitoring, like measuring trough levels to ensure effective and safe treatment against MRSA” – Participant 13

2.9. “I will try to educate the health care teams about the misuse of antibiotics, the disadvantages and the complications. So, they need to learn more about stewardship, its benefits and how they should be more aware of what's better for the patient.” – Participant 10