Below is the citation and author summary of a new paper in PLOS Medicine.
CITATION: Adherence to smartphone-delivered antimicrobial prescribing guidelines in hospitals in Lao PDR: A stepped-wedge cluster randomized controlled trial. Chansamouth et al. Published: August 27, 2026
https://doi.org/10.1371/journal.pmed.1005205
Author summary
Why was this study done?
Inappropriate use of antimicrobials is a key driver of antimicrobial resistance (AMR). Providing clear, accessible guidelines is an essential step toward improving prescribing practices.
Some evidence suggests that delivering guidelines via simple technologies, such as smartphone applications, can support better antimicrobial use and hospital stewardship. However, most reports come from high-income country settings.
What did the researchers do and find?
We conducted a stepped-wedge cluster randomized controlled trial in six hospitals across Laos..
A total of 3,561 inpatient and 3,905 outpatient antimicrobial prescriptions were assessed...
What do these findings mean?
The results highlight that antimicrobial prescribing guideline availability alone does not guarantee adherence, suggesting that a multifaceted approach is needed to effectively support the use of prescribing guidelines.
An important limitation of this study is that prescribing was assessed using patients’ medical records, and prescriptions could not be reliably linked to individual prescribers. Therefore, changes in prescribing behavior at the individual prescriber level after the guideline implementation could not be evaluated.
COMMENTARY
Shchepanik K, Bai AD, Wise H (2026) Antimicrobial stewardship in low- and middle-income countries: Access versus adherence. PLoS Med 23(8): e1005218. https://doi.org/10.1371/journal.pmed.1005218
'Can improving access to antimicrobial guidelines improve prescriber adherence? In a recent study published in PLOS Medicine (the LAMPA trial), a smartphone app did not improve adherence despite enhanced access to guidelines, highlighting that prescriber behavior is complex, and effective antimicrobial stewardship interventions need to be multifaceted and sustained.'
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org