Outpatient antibiotic prescribing behavior and their psychosocial
predictors among early-career clinicians in Delhi, India
Abstract
Background: Psychosocial factors are significant drivers of
inappropriate antibiotic prescription leading to antibiotic resistance
(ABR). Objective: To ascertain the psychosocial predictors of outpatient
antibiotic prescribing behavior among early-career clinicians in India.
Methods: We enrolled 200 early-career clinicians, including 100 medical
interns and 100 junior residents (postgraduate student doctors) in six
clinical departments, and collected data using a self-administered
questionnaire. Response options were coded on five-item Likert scales.
Results: Antimicrobial resistance (AMR) was viewed as a significant
public health problem by most (95%) participants. Presumptive
antibiotic prescribing was reported by 84% of participants, although
the participant attitude indicated a slight disinclination against the
presumptive use of antibiotics (Mean = 2.8, SD = 0.72). The majority
(52.5%) of the participants’ perceived social pressure frequently
influenced their decision to prescribe antibiotics to their outpatients,
which was most commonly attributed to patient expectation for
antibiotics and from observing the antibiotic prescribing behavior of
their peers and colleagues. The perception of increased social pressure
stipulating antibiotic prescribing negatively correlated with the
participant’s intention to reduce antibiotic use in outpatients
(r=-0.124, p < 0.001). Social pressure was reported to be
higher when treating adult patients reporting diarrheal symptoms, and
children having cough. Conclusions: Outpatient antibiotic prescribing
practices among early-career clinicians working in the government health
sector in India are mediated by considerable social pressure despite
their perceived intention for reducing antibiotic use.