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.