Antibiotic User Guide - a new WHO guidance tool (5) Overprescribing of antibiotics

23 November, 2020

Dear hifa colleagues,

Thank you for bringing up this important discussion.

Community health campaigns on the use of antibiotics and on AMR have a crucial role in raising awareness regarding the implications of overusing these vital resources. For that reason, they are included in one of the main goals in the WHO (2015) Global Action Plan for AMR. However, studies have shown that such an approach has many limitations in practice (see for example Haenssgen and colleagues, 2018). And we could point out several reasons for that, not only including how such health messages are designed and delivered, but also and especially the assumptions behind them. In many cases, such approaches assume that people act 'irrationally', put much of the responsibility/blame on patients, and often neglect the social and economic context that may influence the need for such 'quick' solutions (for both patients and prescribers).

Some social science studies have also shown that although patients' expectations over doctors to prescribe exist, in many cases it is the doctors' own perceptions of those expectations that lead to overprescribing practices. I found in my own research that patients are often unhappy to be quickly dismissed from the consultation room with a prescription, when they feel they have not been appropriately examined by the doctor. Improving their relationship, their communication, their mutual understanding and respect, is also a way of building more trustworthy relationships.

Each local context is different. Therefore, there is a need for deeper local understanding of not only individual reasons (which includes individuals in the community, prescribers, dispensers, hospital managers, policy makers, etc.) but also of the structural problems that create both the need of antimicrobials in the first place, and the conditions for their unnecessary use. Therefore, although very important, awareness campaigns may have very limited effects if all these other aspects are not taken into account.

Massimo, you may also find the work of Nahar, Rousham and colleagues of interest. They have been conducting research in Bangladesh and one of the aspects they look at is the role of medical representatives in promoting antibiotic prescribing and dispensing. I believe that more work on this in other contexts should also be done.

Reference cited: Marco J Haenssgen, Thipphaphone Xayavong, Nutcha Charoenboon, Penporn Warapikuptanun, Yuzana Khine Zaw (2018), The Consequences of AMR Education and Awareness Raising: Outputs, Outcomes, and Behavioural Impacts of an Antibiotic-Related Educational Activity in Lao PDR. https://pubmed.ncbi.nlm.nih.gov/30388824/

Best wishes,

Carla Rodrigues.

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Carla F. Rodrigues

Research Associate, Population Health Sciences

Bristol Medical School | University of Bristol

PhD Candidate, Department of Anthropology

AISSR | University of Amsterdam

Researcher, Centre for Research and Studies in Sociology

CIES, ISCTE-IUL | Instituto Universitário de Lisboa

Latest publications:

Entre o risco e a (in)certeza: o papel da confiança nas práticas e relações sociais com medicamentos. In Medicamentos, Cultura y Sociedad (E-book)

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

Beyond health: medicines, food supplements, energetics and the commodification of self-performance in Maputo, Sociology of Health & Illness.

Social science research contributions to antimicrobial resistance: protocol for a scoping review, Systematic Reviews.

HIFA profile: Carla F Rodrigues is a PhD candidate at the Amsterdam Institute for Social Sciences Research, University of Amsterdam (where she lives currently) and a researcher at the Centre for Research and Studies in Sociology, University Institute of Lisbon. Her main research interests are Sociology of Health, Education and Culture, specifically lay rationalities in health; therapeutic pluralism; and pharmaceuticals consumption. She has been conducting fieldwork in Portugal and Mozambique. She is a member of the HIFA working group on Information for Prescribers and Users of Medicines.

http://www.hifa.org/projects/prescribers-and-users-medicines

http://www.hifa.org/support/members/carla

carla.af.rodrigues AT gmail.com