Study Reveals Provider Misunderstandings Fuel Excessive Antibiotic Use for Children’s Diarrhea in India

A recent study published in Science Advances uncovers that healthcare providers in India's private sector are overprescribing antibiotics for pediatric diarrhea primarily due to misperceptions about patient expectations, rather than a lack of knowledge or financial incentives. Researchers from USC and Duke University analyzed data from 2,282 private healthcare providers across 253 towns, revealing that 70% of providers prescribed antibiotics even when there were no signs of bacterial infection, and 62% of those who knew antibiotics were unnecessary still prescribed them during standardized patient interactions. The study suggests that simply addressing the knowledge gap would only reduce inappropriate prescriptions by about 6 percentage points, whereas correcting provider misbeliefs about patient preferences could decrease it by nearly 30 percentage points.

Experiments indicated that providers’ beliefs about parental demands heavily influenced prescribing behaviors. When caregivers expressed a preference for oral rehydration salts (ORS), prescribing of antibiotics fell significantly, especially among pharmacies. Interestingly, removing financial incentives or increasing ORS supply did not substantially affect prescribing patterns, highlighting the importance of communication and perception.

Further caregiver surveys confirmed that parents do not prefer antibiotic treatment for diarrhea but often believe providers think they do. As lead author Zachary Wagner noted, many children receive unnecessary antibiotics, contributing to global antibiotic resistance. The study emphasizes that changing provider perceptions about parental demands could be a highly effective strategy for antimicrobial stewardship.

The research points out that informal providers and pharmacies exhibit the largest know-do gaps, suggesting targeted interventions—like empowering caregivers to prefer ORS or public awareness campaigns—could markedly reduce misuse. Experts advocate for policies focusing on improving communication between providers and patients to curb inappropriate antibiotic use, which is crucial in combating antibiotic resistance worldwide.