Antimicrobial resistance, inflammatory responses: a comparative analysis of pathogenicities, knowledge hybrids and the semantics of antibiotic use

Abstract

Antimicrobial resistance is widely recognised as a global threat to human health. This paper explores the mobilisation of biomedical concepts and technologies within local semantic registers and addresses the implications of translation and knowledge complexity for attempts to mitigate the problem of antibiotic resistance. In China, antibiotics are frequently prescribed for common complaints and are widely available without prescription. Drawing on field research in three rural counties of one province, we show that current patterns of antibiotic use are the result of sociocultural, economic and systems drivers within a medical context that draws on precepts from both biomedicine and Chinese medical knowledge. Comparative analysis with European settings suggests that pathogenicity, the set of explanatory frameworks regarding the production of disease, varies socio-temporally in the causal mechanisms that are prioritised. Incorporated within diagnostic strategies that direct treatment towards the bodily response to infection rather than to the infecting pathogen, 'anti-inflammatory medicine' as the popular term for antibiotics in parts of Asia foregrounds physiological process over microbial invasion. We examine the articulation of biomedical knowledge paradigms within a non-Pasteurian milieu in relation to socio-historical process, including hybridisation between ontologically distinct medical traditions and the heterogeneity of scientific knowledge claims that underpin contemporary practices of antibiotic prescribing. We conclude that the concept of inflammation functions as a boundary object which effectively mediates the interfaces between popular knowledges, biomedical sciences and local medical practices. Our analysis may have wide relevance because popular and scientific understandings of inflammation alike draw on metaphors grounded in universal sensory experience that provides a common basis for culturally diverse conceptual elaboration. Situated understandings of inflammation and associated treatment preferences constitute a contextually coherent response to available medical technologies in community health care. Our analysis also calls into question simplistic interpretations of antibiotic use for non-bacterial conditions as deriving from lack of education or public awareness and suggests a need to reconsider current public health knowledge translation strategies.

Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab, Bangladesh

“…The focus on individual behaviour change needs to be complemented by attention to the dynamic complex processes responsible for knowledge acquisition. We need to understand more about the ways in which social, cultural and economic factors impact on the knowledge, attitudes, beliefs and behaviours of patients, health professionals and the broader public in regard to the use of antimicrobials in human health and agriculture [ 49 , 50 ].…”

Farmers' Perceptions of Preventing Antibiotic Resistance on Sheep and Beef Farms: Risk, Responsibility, and Action

“…Antibiotic resistance has been identified as one of the most serious public health risks facing humanity ( 1 – 3 ). It has been estimated that by 2050 it could result in 10 million deaths a year worldwide ( 1 , 4 ).…”

Self-medication with antibiotics in Maputo, Mozambique: practices, rationales and relationships

“…Much of the literature on self-medication with antibiotics, however, tends to follow a rather normative approach, which regards such practices as problematic and often irrational, frequently overlooking structural aspects, situated circumstances and individuals' own reasoning. Moreover, in framing antibiotic use and ultimately AMR as an 'individual behaviour' problemwhich needs to be 'corrected' through regulatory restrictions and educational campaigns-such approaches neglect broader contextual and relational processes in which antibiotics and other medicines are embedded (see e.g., Tan, 1999;Rodrigues, 2016;Lambert et al, 2019;Willis and Chandler, 2019), which contrasts with the recognised 'connectedness' as promoted by the rhetoric of the 'One Health' approach (Chandler, 2019).…”