Antibiotic overuse in India: It's not about what doctors know, but what they think patients want, says a new study

A new study published in Science Advances uncovers why Indian healthcare providers overprescribe antibiotics for paediatric diarrhoea, pinpointing providers’ mistaken beliefs about patient expectations as the primary culprit rather than knowledge deficits. 

Researchers from the United States and India analysed provider knowledge tests and over 2,000 anonymous standardised patient (SP) visits to 2,282 providers across 253 towns in Karnataka and Bihar.

The study found that “70% of providers prescribed antibiotics without indication of bacterial infection,” despite most childhood diarrhoea cases being viral.

Titled “Investigating the know-do gap in antibiotics prescribing: Experimental evidence from India,” the research highlights a stark divide between knowledge and practice. 

“Knowledge gaps explain little: 62% of providers who knew antibiotics were inappropriate still prescribed them,” the study says.

While 50% of providers demonstrated a “know gap” by incorrectly stating they would prescribe antibiotics in vignettes, closing it would only reduce overprescribing by 6 percentage points. In contrast, “closing this ‘know-do gap’ would reduce prescribing by 30 percentage points.”

Financial incentives, tested by scenarios where no on-site purchase occurred, and ensuring ORS stockouts were addressed showed no significant impact in the study.

A discrete choice experiment further exposed the misconception: “patients do not prefer providers who give antibiotics.”

The study, conducted in diverse settings —rural Bihar and more affluent Karnataka —emphasises targeting misperceptions. 

Providers, averaging 44 years old with 18.5 years of experience, included MBBS doctors (20%), AYUSH practitioners (37%), rural medical practitioners (21%), and pharmacies (22%). The know-do gap was widest among least-trained providers like pharmacists and rural practitioners.

Antimicrobial resistance claims 5 million lives annually, with India dispensing over half a billion private-sector prescriptions yearly. 

 “Our findings indicate that addressing provider misperceptions about patient preferences may be more effective than standard information-based interventions in reducing antibiotic overuse,” the study says.