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Prescriber and dispenser perceptions about antibiotic use in acute uncomplicated childhood diarrhea and upper respiratory tract infection in New Delhi: Qualitative study.
Indian J Pharmacol. 2017 Nov-Dec; 49(6):419-431.IJ

Abstract

OBJECTIVE

The objective of the study was to explore the prescribing practices, knowledge, and attitudes of primary care doctors and community pharmacists, regarding antibiotic use in acute upper respiratory tract infections (URTI) and diarrhea in children to better understand causes of misuse and identify provider suggestions to change such behavior.

MATERIALS AND METHODS

Two focus group discussions (FGDs) each were conducted with primary care government doctors (GDs), private general practitioners (GPs), pediatricians, and community pharmacists in Delhi. Each FGD had 8-12 participants and lasted 2 h. Furthermore, 22 individual face-to-face semi-structured interviews were conducted with providers of varying type and experience at their workplaces. Thematic and summative qualitative content analysis was done.

RESULTS

All groups admitted to overusing antibiotics, GPs appearing to use more antibiotics than GDs and pediatricians for URTI and diarrhea in children. Pharmacists copy the prescribing of neighborhood doctors. Antimicrobial resistance (AMR) knowledge was poor for all stakeholders except pediatricians. Causes for prescribing antibiotics were patient pressure, profit motive, lack of follow-up and in addition for GDs, workload, no diagnostic facility, and pressure to use near-expiry medicines. Knowledge was gained through self-experience, copying others, information from pharmaceutical companies, and for some, training, continuous medical education/conferences. All groups blamed other professional groups/quacks for antibiotic overuse. Interventions suggested were sensitizing and empowering prescribers through training of providers and the public about the appropriate antibiotic use and AMR and implementing stricter regulations.

CONCLUSIONS

A package of interventions targeting providers and consumers is urgently needed for awareness and change in behavior to reduce inappropriate community antibiotic use.

Authors+Show Affiliations

Department of Pharmacology, V. P. Chest Institute, University of Delhi, New Delhi, India.Department of Anthropology, University of Delhi, New Delhi, India.Department of Paediatrics, L. N. Hospital, New Delhi, India.Indian Institute of Health Management Research (IIHMR) University, Jaipur, Rajasthan, India. Department of Health and Nutrition, Institute of Development Studies, University of Sussex, Brighton, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29674796

Citation

Kotwani, Anita, et al. "Prescriber and Dispenser Perceptions About Antibiotic Use in Acute Uncomplicated Childhood Diarrhea and Upper Respiratory Tract Infection in New Delhi: Qualitative Study." Indian Journal of Pharmacology, vol. 49, no. 6, 2017, pp. 419-431.
Kotwani A, Joshi PC, Jhamb U, et al. Prescriber and dispenser perceptions about antibiotic use in acute uncomplicated childhood diarrhea and upper respiratory tract infection in New Delhi: Qualitative study. Indian J Pharmacol. 2017;49(6):419-431.
Kotwani, A., Joshi, P. C., Jhamb, U., & Holloway, K. (2017). Prescriber and dispenser perceptions about antibiotic use in acute uncomplicated childhood diarrhea and upper respiratory tract infection in New Delhi: Qualitative study. Indian Journal of Pharmacology, 49(6), 419-431. https://doi.org/10.4103/ijp.IJP_508_17
Kotwani A, et al. Prescriber and Dispenser Perceptions About Antibiotic Use in Acute Uncomplicated Childhood Diarrhea and Upper Respiratory Tract Infection in New Delhi: Qualitative Study. Indian J Pharmacol. 2017 Nov-Dec;49(6):419-431. PubMed PMID: 29674796.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prescriber and dispenser perceptions about antibiotic use in acute uncomplicated childhood diarrhea and upper respiratory tract infection in New Delhi: Qualitative study. AU - Kotwani,Anita, AU - Joshi,P C, AU - Jhamb,Urmila, AU - Holloway,Kathleen, PY - 2018/4/21/entrez PY - 2018/4/21/pubmed PY - 2018/10/3/medline KW - Antibiotic use KW - antimicrobial resistance KW - behavior and perception KW - focus group discussion KW - qualitative study KW - rational antibiotic use SP - 419 EP - 431 JF - Indian journal of pharmacology JO - Indian J Pharmacol VL - 49 IS - 6 N2 - OBJECTIVE: The objective of the study was to explore the prescribing practices, knowledge, and attitudes of primary care doctors and community pharmacists, regarding antibiotic use in acute upper respiratory tract infections (URTI) and diarrhea in children to better understand causes of misuse and identify provider suggestions to change such behavior. MATERIALS AND METHODS: Two focus group discussions (FGDs) each were conducted with primary care government doctors (GDs), private general practitioners (GPs), pediatricians, and community pharmacists in Delhi. Each FGD had 8-12 participants and lasted 2 h. Furthermore, 22 individual face-to-face semi-structured interviews were conducted with providers of varying type and experience at their workplaces. Thematic and summative qualitative content analysis was done. RESULTS: All groups admitted to overusing antibiotics, GPs appearing to use more antibiotics than GDs and pediatricians for URTI and diarrhea in children. Pharmacists copy the prescribing of neighborhood doctors. Antimicrobial resistance (AMR) knowledge was poor for all stakeholders except pediatricians. Causes for prescribing antibiotics were patient pressure, profit motive, lack of follow-up and in addition for GDs, workload, no diagnostic facility, and pressure to use near-expiry medicines. Knowledge was gained through self-experience, copying others, information from pharmaceutical companies, and for some, training, continuous medical education/conferences. All groups blamed other professional groups/quacks for antibiotic overuse. Interventions suggested were sensitizing and empowering prescribers through training of providers and the public about the appropriate antibiotic use and AMR and implementing stricter regulations. CONCLUSIONS: A package of interventions targeting providers and consumers is urgently needed for awareness and change in behavior to reduce inappropriate community antibiotic use. SN - 1998-3751 UR - https://www.unboundmedicine.com/medline/citation/29674796/Prescriber_and_dispenser_perceptions_about_antibiotic_use_in_acute_uncomplicated_childhood_diarrhea_and_upper_respiratory_tract_infection_in_New_Delhi:_Qualitative_study_ L2 - http://www.ijp-online.com/article.asp?issn=0253-7613;year=2017;volume=49;issue=6;spage=419;epage=431;aulast=Kotwani DB - PRIME DP - Unbound Medicine ER -