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“Without antibiotics, I cannot treat”: A qualitative study of antibiotic use in Paschim Bardhaman district of West Bengal, India
Open accessAbstract
BACKGROUND: Misuse of antibiotics is a well-known driver of antibiotic resistance. Given the decentralized model of the Indian health system and the shortage of allopathic doctors in rural areas, a wide variety of healthcare providers cater to the needs of patients in urban and rural settings. This qualitative study explores the drivers of antibiotic use among formal and informal healthcare providers as well as patients accessing care at primary health centers across Paschim Bardhaman district in West Bengal. MATERIALS AND METHODS: We conducted 28 semi-structured, in-depth interviews with four groups of healthcare providers (allopathic doctors, informal health providers, nurses, and pharmacy shopkeepers) as well as patients accessing care at primary health centers and hospitals across Paschim Bardhaman district. Qualitative data was analyzed using the framework method in an inductive and deductive manner. RESULTS: Our results indicate that patients demand antibiotics from healthcare providers and seek the fastest cure possible, which influences the prescription choices of healthcare providers, particularly informal health providers. Many allopathic doctors provide antibiotics without any clinical indication due to inconsistent follow up, lack of testing facilities, risk of secondary infections, and unhygienic living conditions. Pharmaceutical company representatives actively network with informal health providers and formal healthcare providers alike, and regularly visit providers even in remote areas to market newer antibiotics. Allopathic doctors and informal health providers frequently blame the other party for being responsible for antibiotic resistance, and yet both display interdependence in referring patients to one another. CONCLUSIONS: A holistic approach to curbing antibiotic resistance in West Bengal and other parts of India should focus on strengthening the capacity of the existing public health system to deliver on its promises, improving patient education and counseling, and including informal providers and pharmaceutical company representatives in community-level antibiotic stewardship efforts.
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“Instead, when a resident's infection does not respond to an initial round of antibiotics, healthcare providers often simply provide different types of antibiotics at escalating prices 24 .”
From Urban informal settlements as hotspots of antimicrobial resistance and the need to curb environmental transmission. (2020) · cites this paper as [24]
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Nadimpalli, M. L., Marks, S. J., Montealegre, M. C., Gilman, R. H., Pajuelo, M. J., Saito, M., Tsukayama, P., Njenga, S. M., Kiiru, J., Swarthout, J., et al. (2020) · Nature microbiology · doi:10.1038/s41564-020-0722-0 · Cited by 223
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Overuse of medications in low- and middle-income countries: a scoping review
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Metadata
- Authors
- Nair, M., Tripathi, S., Mazumdar, S., Mahajan, R., Harshana, A., Pereira, A., Jimenez, C., Halder, D., & Burza, S.
- Affiliations
- Médecins Sans Frontières (US)
- School of Tropical Medicine (IN)
- University of York (GB)
- Médecins Sans Frontières (ES)
- Government of West Bengal (IN)
- Corresponding author
- Burza, Sakib
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2019-06-27
- Volume
- 14
- Issue
- 6
- Pages
- e0219002
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6597109
- OpenAlex
- W2954468625
- Cited by
- 57
- References
- 30
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 7 · 2023: 7 · 2022: 5 · 2021: 15 · 2020: 7 · 2019: 1
- FWCI
- 4.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
- Health Sciences › Nursing › Issues, ethics and legal aspects › Pharmaceutical industry and healthcare
- Health Sciences › Medicine › Microbiology (medical) › Antibiotic Resistance in Bacteria
- Keywords
- antibiotic misuse, antibiotic resistance, informal health providers, primary health centers, antibiotic prescribing, referral networks, antibiotic stewardship, rural health care
- MeSH terms
- Antimicrobial Stewardship, Drug Misuse, Anti-Bacterial Agents, Drug Resistance, Microbial, Health Personnel, Humans, India, Health Knowledge, Attitudes, Practice, Public Health, Surveys and Questionnaires, Rural Health, Qualitative Research
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