A new study published in Science Advances uncovers a key reason behind rampant antibiotic overprescription for paediatric diarrhoea in India. The researchers found that healthcare providers’ mistaken beliefs about patient expectations, rather than knowledge deficits, drive this widespread practice.
Large-Scale Study Across Two States
Researchers from the United States and India analysed provider knowledge tests and conducted over 2,000 anonymous standardised patient (SP) visits to 2,282 providers across 253 towns in Karnataka and Bihar.
As reported by tribuneindia, the findings were striking: 70% of providers prescribed antibiotics without any indication of bacterial infection, even though most childhood diarrhoea cases are viral and self-limiting.
Knowledge-Practice Divide Identified
The study, titled “Investigating the Know-Do Gap in Antibiotics Prescribing: Experimental Evidence from India,” highlights a sharp gap between what providers know and what they actually do.
Notably, 62% of providers who knew antibiotics were inappropriate still prescribed them. Although half of the providers demonstrated a “knowledge gap” by incorrectly stating in vignettes that they would prescribe antibiotics, closing this gap would only reduce overprescription by 6 percentage points. In contrast, closing the “know-do gap” could reduce unnecessary prescribing by 30 percentage points.
Misperceptions, Not Incentives, Drive Overuse
The study ruled out financial incentives and stock availability as major drivers. Scenarios with no on-site drug purchase and full ORS availability showed no significant change in prescribing behaviour.
Instead, a discrete choice experiment revealed a critical insight: patients do not prefer providers who prescribe antibiotics. This finding underscores that providers’ assumptions about patient expectations are misplaced.
Patterns Across Provider Types
The study included a diverse provider mix: MBBS doctors (20%), AYUSH practitioners (37%), rural medical practitioners (21%), and pharmacies (22%). Providers had an average age of 44 years and 18.5 years of experience.
The know-do gap was widest among the least-trained providers, such as pharmacists and rural medical practitioners, suggesting that interventions must specifically address these groups.
Urgent Need to Curb Antibiotic Misuse
India dispenses over half a billion private-sector antibiotic prescriptions every year, contributing to the global antimicrobial resistance crisis that claims 5 million lives annually.
The authors conclude, “Addressing provider misperceptions about patient preferences may be more effective than standard information-based interventions in reducing antibiotic overuse.”