The University of Sydney, Sydney, New South Wales, Australia.
Australian National University, Canberra, Australian Capital Territory, Australia.
Qual Health Res. 2020 Sep;30(11):1684-1696. doi: 10.1177/1049732320919088. Epub 2020 May 27.
India is considered the epicenter of the global antimicrobial resistance crisis, with unprecedented antimicrobial consumption, production, and "misuse." But the story of resistance in India is complicated-emerging from intersections of industrial pharmaceutical development, rationing/purchasing of health care, policy infrastructure, and dynamics of disadvantage. What looks like rampant, escalating antimicrobial misuse and a need for tighter controls over drugs and "prescribers," emerges as a complex social problem. These dimensions reach the bedside, although variously, with doctors in India dealing with precarious infectious disease landscapes, threats of multidrug-resistant organisms, and (pan) national imperatives for "more judicious" practices. Drawing on 24 semi-structured interviews with doctors in Hyderabad, we explore their perspectives on resistance (literal and figurative) in everyday practice, and how practices articulate intersections of power, influence, and governance. This offers broader context to reframe resistance in India as multifactorial, enacted through cultural/local practices, and irreducible to singular problems of control or regulation.
印度被认为是全球抗微生物药物耐药性危机的中心，其抗微生物药物的消费、生产和“滥用”都达到了前所未有的程度。但印度的耐药性问题十分复杂，其产生的原因来自于工业制药的发展、医疗保健的配给/购买、政策基础设施以及劣势的动态变化。表面上看似猖獗、不断升级的抗微生物药物滥用和对药物和“处方者”更严格的控制的需求，实际上是一个复杂的社会问题。尽管在各个方面有所不同，但这些层面都在印度的病床上有所体现，印度的医生们正在应对不稳定的传染病情况、多药耐药生物体的威胁，以及（泛）国家对抗微生物药物“更明智”使用的必要性。本研究通过对海得拉巴的 24 名医生进行半结构化访谈，探讨了他们在日常实践中对抗微生物药物耐药性（字面和比喻意义上）的看法，以及这些实践如何阐明权力、影响和治理的交叉点。这为重新构建印度的耐药性问题提供了更广泛的背景，将其视为多因素的，通过文化/当地实践来实施的，而不能简化为单一的控制或监管问题。
