Medecins Sans Frontieres, New Delhi, India.
Calcutta School of Tropical Medicine, Kolkata, India.
PLoS One. 2019 Jun 27;14(6):e0219002. doi: 10.1371/journal.pone.0219002. eCollection 2019.
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.
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.
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.
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.
抗生素的滥用是导致抗生素耐药性的一个众所周知的因素。鉴于印度卫生系统的分散模式以及农村地区的全药师短缺，各种各样的医疗保健提供者都满足了城市和农村地区患者的需求。这项定性研究探讨了在西孟加拉邦帕斯希姆巴尔德汉姆区的初级保健中心，正规和非正规医疗保健提供者以及寻求医疗保健的患者使用抗生素的驱动因素。
我们对帕斯希姆巴尔德汉姆区的四个群体的医疗保健提供者（全药师、非正规卫生提供者、护士和药店店主）以及在初级保健中心和医院就诊的患者进行了 28 次半结构化深入访谈。使用框架方法对定性数据进行了归纳和演绎分析。
我们的结果表明，患者向医疗保健提供者要求使用抗生素并寻求最快的治愈方法，这影响了医疗保健提供者的处方选择，特别是非正规卫生提供者。许多全药师由于缺乏一致性的随访、缺乏检测设施、继发感染的风险和不卫生的生活条件，在没有任何临床指征的情况下开抗生素。制药公司代表积极与非正规卫生提供者和正规医疗保健提供者建立联系，并定期到偏远地区向提供者推销更新的抗生素。全药师和非正规卫生提供者经常互相指责对方对抗生素耐药性负责，但双方都表现出相互依赖，将患者转介给对方。
在西孟加拉邦和印度其他地区遏制抗生素耐药性的整体方法应侧重于加强现有公共卫生系统的能力，以兑现其承诺，改善患者教育和咨询，并将非正规提供者和制药公司代表纳入社区一级的抗生素管理工作。
