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Background <p>The timely switch of antibiotics from intravenous route to an oral regimen (IV-to-PO) is a critical antimicrobial stewardship approach, but unfortunately, it is still inconsistently practiced, most notably in low- and middle-income countries. To date, no study evaluated the knowledge, practices, and perceived barriers of this transition among Iraqi physicians.</p> Objective <p>The study aims to assess IV-to-PO switching knowledge, self-reported practices, and perceived barriers among Iraqi hospital physicians.</p> Methods <p>During the period from October to December 2025, a cross-sectional survey was conducted on a sample of 400 physicians from hospitals in Baghdad, Erbil, and Basra, using a reliable, valid questionnaire (Cronbach's α = 0.79–0.81). Analysis of knowledge (0–5) and practice (0–100) scores were performed using ANOVA, Pearson correlation, and multiple linear regression.</p> Results <p>It was revealed that the level of knowledge was poor, especially in relation to hemodynamic stability criteria and oral bioavailability. Just 22.8% of physicians stated that they always switch when clinically indicated with an average practice score of 56.7 ± 16.7/100. Importantly, knowledge was not a predictor of practice (r = 0.087, p = 0.110). Major reasons for nonpracticing were gastrointestinal absorption issues (47.0%), lack of institutional protocols (40.5%), and hierarchical resistance from senior physicians (39.5%). Clinical experience (β = 0.31, p &lt; 0.001) and hospital setting (β = 0.19, p = 0.003) were significant predictors of practice scores. </p> Conclusion <p>Underutilization of IV-to-PO switch in Iraq indicate institutional and cultural inertia and not solely knowledge gaps. The observed disengagement between knowledge and practice reveals that improving knowledge alone may not be effective to optimize IV-to-Po switching of antibiotics. Multimodal interventions standardized protocols, pharmacist-led stewardship, and senior clinician engagement are essential to translating evidence into bedside practice.</p>

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Knowledge, practices, and perceived barriers regarding intravenous to oral antibiotic switch therapy among physicians in Iraqi hospitals

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  • 发表日期：

    2026年7月15日

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  • Alyaa Hussein Hammadi,
  • Samer Imad Mohammed,
  • Fadia Thamir Ahmed

摘要

Background

The timely switch of antibiotics from intravenous route to an oral regimen (IV-to-PO) is a critical antimicrobial stewardship approach, but unfortunately, it is still inconsistently practiced, most notably in low- and middle-income countries. To date, no study evaluated the knowledge, practices, and perceived barriers of this transition among Iraqi physicians.

Objective

The study aims to assess IV-to-PO switching knowledge, self-reported practices, and perceived barriers among Iraqi hospital physicians.

Methods

During the period from October to December 2025, a cross-sectional survey was conducted on a sample of 400 physicians from hospitals in Baghdad, Erbil, and Basra, using a reliable, valid questionnaire (Cronbach's α = 0.79–0.81). Analysis of knowledge (0–5) and practice (0–100) scores were performed using ANOVA, Pearson correlation, and multiple linear regression.

Results

It was revealed that the level of knowledge was poor, especially in relation to hemodynamic stability criteria and oral bioavailability. Just 22.8% of physicians stated that they always switch when clinically indicated with an average practice score of 56.7 ± 16.7/100. Importantly, knowledge was not a predictor of practice (r = 0.087, p = 0.110). Major reasons for nonpracticing were gastrointestinal absorption issues (47.0%), lack of institutional protocols (40.5%), and hierarchical resistance from senior physicians (39.5%). Clinical experience (β = 0.31, p < 0.001) and hospital setting (β = 0.19, p = 0.003) were significant predictors of practice scores.

Conclusion

Underutilization of IV-to-PO switch in Iraq indicate institutional and cultural inertia and not solely knowledge gaps. The observed disengagement between knowledge and practice reveals that improving knowledge alone may not be effective to optimize IV-to-Po switching of antibiotics. Multimodal interventions standardized protocols, pharmacist-led stewardship, and senior clinician engagement are essential to translating evidence into bedside practice.