Abstract

BackgroundAntibiotic resistance is a global public health crisis. In India alone, multi-drug resistant organisms are responsible for over 58,000 infant deaths each year. A major driver of drug resistance is antibiotic misuse, which is a pervasive phenomenon worldwide. Due to a shortage of trained doctors, access to licensed allopathic doctors is limited in India’s villages. Pharmacists and unlicensed medical providers are commonly the primary sources of healthcare. Patients themselves are also key participants in the decision to treat an illness with antibiotics. Thus, better understanding of the patient-provider interactions that may contribute to patients’ inappropriate use of antibiotics is critical to reducing these practices in urban and rural Indian villages.MethodsWe conducted a qualitative study of the social determinants of antibiotic use among twenty community members in Haryana, India. Semi-structured interview questions focused on two domains: typical antibiotic use and the motivation behind these practices. A cross-sectional pilot survey investigated the same twenty participants’ understanding and usage of antibiotics. Interview and open-ended survey responses were translated, transcribed, and coded for themes.ResultsAntibiotics and the implications of their misuse were poorly understood by study participants. No participant was able to correctly define the term antibiotics. Participants with limited access to an allopathic doctor, either for logistic or economic reasons, were more likely to purchase medications directly from a pharmacy without a prescription. Low income participants were also more likely to prematurely stop antibiotics after symptoms subsided. Regardless of income, participants were more likely to seek an allopathic doctor for their children than for themselves.ConclusionsThe prevalent misuse of antibiotics among these community members reinforces the importance of conducting research to develop effective strategies for stemming the tide of antibiotic resistance in India’s villages.

Highlights

  • Antibiotic resistance is a global public health crisis

  • We performed a qualitative study of the social determinants of antibiotic use among community members in Haryana, India, to investigate how healthcare access, health knowledge, and income impacts patients’ antibiotic use practices

  • While the study populations are not comparable, it is important to note that 65% is much higher than the 37% result found in a recent World Health Organization (WHO) survey of antibiotic use in India [35]

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Summary

Introduction

Antibiotic resistance is a global public health crisis. In India alone, multi-drug resistant organisms are responsible for over 58,000 infant deaths each year. A major driver of drug resistance is antibiotic misuse, which is a pervasive phenomenon worldwide. Pharmacists and unlicensed medical providers are commonly the primary sources of healthcare. Better understanding of the patient-provider interactions that may contribute to patients’ inappropriate use of antibiotics is critical to reducing these practices in urban and rural Indian villages. Antibiotic resistance is a global public health crisis. A major driver of drug resistance is antibiotic misuse, which is pervasive. Studies of patients in these settings often focus on their interaction with doctors or advanced practice providers, who control access to antibiotics through written prescriptions. Pharmacists and unlicensed rural medical providers (RMPs) are commonly the primary sources of healthcare [16,17,18]

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