Abstract
Informal healthcare providers (IHCPs) are predominant healthcare providers in rural India, who prescribe without formal training. Antibiotic prescription by IHCPs could provide crucial information for controlling antibiotic resistance. The aim of this study is to determine the practices and seasonal changes in antibiotic prescribing for common illnesses by IHCPs. A repeated cross-sectional study was conducted over 18 months, covering different seasons in the rural demographic surveillance site, at Ujjain, India. Prescriptions given to outpatients by 12 IHCPs were collected. In total, 15,322 prescriptions for 323 different complaint combinations were analyzed, of which 11,336 (74%) included antibiotics. The results showed that 14,620 (95%) of antibiotics prescribed were broad spectrum and the most commonly prescribed were fluoroquinolones (4771,31%), followed by penicillin with an extended spectrum (4119,27%) and third-generation cephalosporin (3069,20%). Antibiotics were prescribed more frequently in oral and dental problems (1126,88%), fever (3569,87%), and upper respiratory tract infections (3273, 81%); more during the monsoon season (2350,76%); and more frequently to children (3340,81%) than to adults (7996,71%). The study concludes that antibiotics were the more commonly prescribed drugs compared to other medications for common illnesses, most of which are broad-spectrum antibiotics, a situation that warrants further investigations followed by immediate and coordinated efforts to reduce unnecessary antibiotic prescriptions by IHCPs.
Highlights
Antibiotic resistance (ABR) has become a major threat to global health and is regarded as a complex multidimensional crisis [1]
All the informal healthcare providers (IHCPs) who participated in the study were men
The results of our study reveal that the IHCPs prescribed antibiotics at a high proportion (74%) for common illnesses compared to other non-antibiotic medications
Summary
Antibiotic resistance (ABR) has become a major threat to global health and is regarded as a complex multidimensional crisis [1]. Multiple factors are responsible for human ABR in LMICs, including the high burden of infectious diseases, poor hygiene and infection control measures, the easy availability of antibiotics, the indiscriminate use of antibiotics, the poor quality of diagnostics, the lack of availability of treatment guidelines, non-adherence to treatment guidelines, and the diverse and fragmented healthcare systems [4,5,6,7]. India has a large three-tier public healthcare system that ensures easy access to primary care, irrespective of the socioeconomic condition of an individual; this system has been ineffective in providing primary care in rural areas [8]. Failure of the public healthcare system has resulted in the evolution of private healthcare systems [8], which cater to 78% and 60% of outpatients and inpatients, respectively, in India [11]
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