Skender Kristina, Machowska Anna, Khare Shweta, Singh Vivek, Lundborg Cecilia Stålsby, Sharma Megha
Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, 17177, Sweden.
Department of International Centre for Health Research, Ruxmaniben Deepchand Gardi Medical College, Ujjain, 456006, India.
Sci Rep. 2025 Jul 11;15(1):25099. doi: 10.1038/s41598-025-11173-w.
India has one of the world's highest burdens of antimicrobial resistance (AMR). Broad-spectrum antibiotics are routinely and empirically initiated in surgery and orthopedic departments, contributing to the AMR. This study aimed to explore the capabilities, opportunities and motivation that influence antibiotic prescribing practices of general and orthopedic surgeons in Central India. This qualitative study was guided by the Capability, Opportunity, Motivation-Behavior model (COM-B) and the Theoretical Domains Framework (TDF). Semi-structured interviews were conducted until redundancy was achieved, including 15 general and orthopedic surgeons in three private-sector hospitals in Ujjain district. Questions were formulated to explore how decisions about antibiotic prescribing are made, and surgeons´ perceptions of antibiotic use, AMR and potential solutions. Manifest and latent content analysis was used. Three main themes were revealed: (1) Antibiotic prescribing decision is a multifactorial process influenced by environmental and sociocultural factors; (2) Infection prevention and control (IPC), diagnostics and treatment need strengthening; (3) AMR is a social problem that requires a collective effort. Participants emphasized the critical role of environmental (e.g., dusty rural setting) and sociocultural factors (e.g., patients' socioeconomic status) in influencing antibiotic prescribing decisions. Prescribing practices were mostly empirical and varied between participants. Junior practitioners expressed a strong desire for regulation, guidelines, feedback and improvement, whereas senior practitioners were more confident in their prescribing. Doctors expressed frustration and hopelessness when treating resistant infections and recalled the significant contribution of the COVID-19 pandemic to inappropriate antibiotic use. The AMR problem in India was perceived as a broader social issue requiring collective action. Proposed solutions included strengthening IPC and diagnostic practices, developing contextualized antibiotic prescribing guidelines, stricter regulations on antibiotic use, and public education. Antibiotic prescribing decisions are multifactorial and context-specific, strongly impacted by prescribers' experiences and environmental and sociocultural factors. Our findings could inform future interventions to improve antibiotic use in Central India and beyond.
印度是全球抗微生物药物耐药性（AMR）负担最高的国家之一。在外科和骨科科室，广谱抗生素通常是按照经验常规使用，这加剧了抗微生物药物耐药性问题。本研究旨在探讨影响印度中部普通外科医生和骨科医生抗生素处方行为的能力、机会和动机。这项定性研究以能力、机会、动机—行为模型（COM-B）和理论领域框架（TDF）为指导。进行了半结构化访谈，直至达到饱和状态，访谈对象包括印多尔地区三家私立医院的15名普通外科医生和骨科医生。所提问题旨在探究抗生素处方决策是如何做出的，以及医生对抗生素使用、抗微生物药物耐药性和潜在解决方案的看法。采用了显性和隐性内容分析法。研究揭示了三个主要主题：（1）抗生素处方决策是一个受环境和社会文化因素影响的多因素过程；（2）感染预防与控制（IPC）、诊断和治疗需要加强；（3）抗微生物药物耐药性是一个需要集体努力解决的社会问题。参与者强调了环境因素（如尘土飞扬的农村环境）和社会文化因素（如患者的社会经济地位）在影响抗生素处方决策方面的关键作用。处方行为大多基于经验，且参与者之间存在差异。初级从业者强烈希望有相关规定、指南、反馈和改进措施，而资深从业者对自己的处方更有信心。医生在治疗耐药感染时表示沮丧和无助，并回忆起新冠疫情对抗生素不当使用的重大影响。印度的抗微生物药物耐药性问题被视为一个需要集体行动的更广泛的社会问题。提议的解决方案包括加强感染预防与控制及诊断措施、制定因地制宜的抗生素处方指南、对抗生素使用实施更严格的监管以及开展公众教育。抗生素处方决策是多因素且因地制宜的，受到开处方者的经验以及环境和社会文化因素的强烈影响。我们的研究结果可为未来改善印度中部及其他地区抗生素使用的干预措施提供参考。
