**Addressing Antibiotic Overprescription for Child Diarrhea in India: Understanding Provider Misperceptions through a Study** The study highlights the reasons behind excessive prescribing by identifying misperceptions among providers and suggests necessa

Doctor’s Beliefs, Not Profits, Fuel Antibiotic Overuse in India

September 23, 2025

A new study highlights a meaningful disconnect between what doctors no about appropriate antibiotic use and their actual prescribing habits.

New Delhi, India – A groundbreaking study indicates that a significant factor contributing to the overuse of antibiotics for childhood diarrhea in India is not a lack of medical knowledge or financial gain, but rather a misinterpretation of what parents expect. Researchers discovered that physicians frequently prescribe antibiotics believing parents demand “strong” medicines, even when those medications are unnecessary and potentially harmful.

The ‘Know-Do Gap’ Drives Inappropriate Prescriptions

The research, conducted across 253 towns and involving 2,282 private healthcare providers, revealed that approximately 70 Percent of doctors prescribed antibiotics even when there were no indications of a bacterial infection. Remarkably, over 60 Percent of those physicians acknowledged that antibiotics were not the correct course of treatment, yet still prescribed them. This disconnect between knowledge and action is termed the “know-do gap.”

Investigators found that closing this “know-do gap” could reduce inappropriate antibiotic use by roughly 30 percentage points. Eliminating the knowledge gap alone would only cut overuse by about 6 percentage points, signifying the prevalence of the issue.

Patient Preferences Misunderstood

Contrary to assumptions, the study found that point-of-sale incentives and limited availability of Oral Rehydration Solutions (ORS) were not primary drivers of antibiotic overuse. Instead, provider beliefs about patient demand played a crucial role. Experiments showed that when patients explicitly requested ORS, inappropriate antibiotic prescriptions decreased by an average of 17 percent, particularly among pharmacies.

Further examination with 1,189 caregivers showed that parents did not, in fact, prefer antibiotics over ORS, underscoring a misalignment between provider perceptions and actual patient wishes. This points to a critical need for improved dialog between doctors and patients.

“Our findings demonstrate a striking disconnect: clinicians are aware that antibiotics are frequently enough ineffective for diarrhea, but they prescribe them anyway out of a belief that parents expect stronger medication,” explained a lead researcher from the USC’s Center for Economic and Social Research. “Addressing this perception, rather than relying on additional training, offers the most effective pathway towards responsible antibiotic stewardship.”

The Global Implications of Antibiotic Misuse

Experts emphasize that the widespread misuse of antibiotics isn’t confined to India, with the World Health Organization (WHO) declaring antimicrobial resistance as one of the top 10 global public health threats in 2024. the overuse of these drugs contributes directly to the progress of drug-resistant bacteria, posing a severe risk to global health security.

Factor	Impact on Antibiotic Use
Eliminating Knowledge Gap	6% reduction in inappropriate use
Closing Know-Do Gap	30% reduction in inappropriate use
Patient Preference for ORS	17% reduction in inappropriate use
Removing Financial Incentives	No significant impact

“By revealing that communication between patients and physicians is more influential than financial factors, we provide policymakers with a clear target: help doctors understand and respond to realistic patient preferences,” added a co-author from the USC Schaeffer Center and Price School.

The study also highlighted that less formally trained providers and pharmacies exhibited the largest “know-do gaps,” indicating that targeted interventions could be particularly impactful in these settings.

Antibiotic Resistance: A Growing Global Threat

Antibiotic resistance occurs when bacteria evolve and no longer respond to the drugs designed to kill them. This is a natural phenomenon, but the misuse and overuse of antibiotics are accelerating it.According to the World Health Organization,antimicrobial resistance is already directly responsible for an estimated 1.27 million deaths globally each year.

Did You Know? the Centers for Disease Control and Prevention (CDC) estimates that at least 30% of outpatient antibiotic prescriptions in the U.S. are unnecessary.

Promoting responsible antibiotic use – including only prescribing them when truly needed – is a critical step in slowing the spread of antibiotic resistance and protecting future generations.

Frequently Asked Questions about Antibiotic Use

What is the “know-do gap” in healthcare?

The “know-do gap” refers to the discrepancy between what healthcare professionals know to be best practice and what they actually do in clinical settings.

Why are antibiotics sometimes prescribed unnecessarily for diarrhea?

This study shows that misperceptions about patient expectations are a major driver, with doctors believing parents want antibiotics even when they aren’t needed.

What is Oral Rehydration Solution (ORS)?

ORS is a simple, inexpensive solution containing electrolytes and sugar that helps prevent dehydration caused by diarrhea.

How does antibiotic overuse contribute to drug resistance?

The more antibiotics are used, the more opportunities bacteria have to evolve and become resistant to their effects.

What can patients do to promote responsible antibiotic use?

patients shoudl ask their doctors if antibiotics are truly necessary,and explore alternative treatments like ORS when appropriate.

What are your thoughts on the findings of this study? Do you believe better communication between doctors and patients is key to reducing antibiotic misuse? Share your perspective in the comments below!

What specific parental expectations regarding antibiotic prescriptions were identified as influencing healthcare provider decisions in the study?

Addressing Antibiotic Overprescription for Child Diarrhea in India: Understanding Provider Misperceptions through a Study

The Scope of the Problem: Antibiotic Use & Childhood Diarrhea

Childhood diarrhea remains a important public health concern in India, contributing substantially to under-five mortality. While often viral in origin, a concerning trend is the widespread and often inappropriate use of antibiotics to treat thes cases. This overprescription isn’t just ineffective against viral infections; it fuels antibiotic resistance, a growing global threat.The unneeded exposure to antibiotics disrupts the gut microbiome,perhaps leading to long-term health consequences for children. Terms like “acute diarrhea in children,” “pediatric diarrhea treatment India,” and “antibiotic resistance India” are frequently searched, highlighting public concern.

Identifying Provider Misperceptions: Key Findings from Recent research

A recent study aimed to pinpoint the reasons behind this excessive antibiotic prescribing for child diarrhea among healthcare providers in India.The research revealed several key misperceptions:

* Perceived Severity: Providers often overestimate the risk of bacterial infection and severe complications from diarrhea, leading to a precautionary approach of prescribing antibiotics.

* Parental Expectations: A strong belief that parents expect antibiotics, and a fear of dissatisfaction if they aren’t prescribed, substantially influences prescribing decisions. This creates a cycle of demand and supply.

* Lack of Diagnostic resources: Limited access to affordable and reliable diagnostic tools to differentiate between viral and bacterial causes of diarrhea contributes to presumptive antibiotic use.

* Knowledge Gaps: Some providers demonstrate a lack of up-to-date knowledge regarding evidence-based guidelines for managing childhood diarrhea, especially regarding oral rehydration therapy (ORT) and zinc supplementation.

* Influence of Pharmaceutical Marketing: Exposure to pharmaceutical company promotions can subtly influence prescribing habits, even unconsciously.

These findings are crucial because they move beyond simply identifying that overprescription exists, and delve into why it’s happening.Keywords like “diarrhea management guidelines India,” “ORT for children,” and “zinc supplementation diarrhea” are vital for promoting correct treatment protocols.

The Role of Oral Rehydration Therapy (ORT) and Zinc

ORT remains the cornerstone of managing acute diarrhea in children.It effectively replaces lost fluids and electrolytes, preventing dehydration – the most dangerous complication of diarrhea. Zinc supplementation, when administered alongside ORT, has been proven to reduce the duration and severity of diarrhea episodes.

Here’s a breakdown of ORT best practices:

1. Assess Dehydration: Determine the level of dehydration (mild, moderate, or severe).
2. Prepare ORS Solution: Use commercially available ORS packets, following the instructions carefully. Avoid homemade solutions, as they can be imbalanced.
3. Administer ORS: Give small,frequent sips of ORS solution.
4. Continue Feeding: Encourage continued breastfeeding or age-appropriate feeding during diarrhea.

Interventions to Align Prescribing Practices with Evidence-Based Guidelines

Addressing provider misperceptions requires a multi-pronged approach:

* Continuing Medical Education (CME): regular CME programs focusing on updated diarrhea management guidelines, emphasizing the role of ORT and zinc, and highlighting the dangers of antibiotic overuse.

* Diagnostic Support: Increasing access to affordable and rapid diagnostic tests to differentiate between viral and bacterial causes of diarrhea. Point-of-care testing is particularly valuable in resource-limited settings.

* Behavioral Change Dialog: Strategies to address parental expectations and promote understanding of appropriate diarrhea treatment. This includes public health campaigns and educational materials for parents.

* Clinical Decision Support Systems: Implementing electronic health record systems with built-in clinical decision support tools to guide prescribing decisions.

* Regulation of Pharmaceutical Marketing: Strengthening regulations regarding pharmaceutical company marketing practices to minimize their influence on prescribing habits.

* Audit and Feedback: Regular audits of prescribing practices with constructive feedback to providers.

Real-World Example: the Impact of a CME Program in Rajasthan

In 2018,a CME program was implemented in several districts of Rajasthan,India,focusing on rational antibiotic use for childhood diarrhea. The program included interactive workshops, case studies, and practical training on ORT and zinc administration. A follow-up evaluation showed a significant reduction in antibiotic prescriptions for non-bacterial diarrhea cases among participating providers. This demonstrates the potential impact of targeted interventions.

Benefits of Reducing Antibiotic Overprescription

The benefits extend far beyond individual patient care:

* Reduced Antibiotic Resistance: Slowing the progress and spread of antibiotic-resistant bacteria.

* Improved Child Health: Minimizing the disruption of the gut microbiome and reducing the risk of long-term health consequences.

* Cost Savings: Reducing healthcare costs associated with treating antibiotic-resistant infections.

* Strengthened Public Health: Contributing to a more resilient healthcare system capable of effectively managing infectious diseases.

Practical Tips for Healthcare Providers

* Always assess the level of dehydration before initiating treatment.

* Prioritize ORT and zinc supplementation as the first-line treatment for acute diarrhea.

* **Only prescribe antibiotics