Antibiotic Prescribing and Resistance: Views from LMIC Prescribing and Dispensing Professionals

Principal Investigator: Clare Chandler, LSHTM

Funder: World Health Organisation

Dates: 2017-2018


The resistance of bacteria to an increasing array of antibiotic drugs is a cause of international concern. The widespread use of antibiotics is held responsible to a large extent for the development of drug-resistant strains of infection. In LMICs, this is of particular concern when infections are non-responsive to affordable medicines, and when infections can become serious without antibiotic intervention. We have limited data on prescribing practices and what shapes these at scale. Ideas of ‘rational’ versus ‘irrational’ prescribing are dominant in the public health literature, although these lines appear blurry when faced with patients, and with limited resources. Qualitative research has documented a triad of diagnostic uncertainty, the fear of untreated serious disease and perceived demands from patients and as central to the deviation of prescribing practices from guidelines. Implicit in the current response to concern over AMR is the proposal that knowledge of AMR must be low, and that addressing this through education or awareness raising will reduce prescribing overall, and increase compliance with full dose regimens. However, we know little of the levels of AMR knowledge amongst health professionals around the world. This research addresses this gap. We need to know whether it is knowledge, and/or other factors, that affect antibiotic prescribing at the rates that of such great concern. Equipped with this knowledge, we will be better able to target interventions to support the effective, safe scale-back of use that is proposed to be necessary to curb resistance.


This project aims to understand the awareness of antibiotic resistance (AMR) amongst medical and veterinary professionals across LMICs.

Phase I. In the course of 2017, nine LSHTM students undertook qualitative research to explore awareness of AMR amongst medical and veterinary prescribing and dispensing professionals and the context of antibiotic usage. Countries visited for fieldwork were: Vietnam, Nigeria, India, Philippines, Ethiopia and Sierra Leone. The resulting 246 interview transcripts, together with student fieldnotes and pictures, were analysed to produce a cross-site report of common findings. The draft report is available on the WHO AMR Website. These findings were used, in conjunction with inputs from a range of experts, to design a draft questionnaire that may be used across settings to understand awareness of AMR.

Phase II. In the course of 2018, five LSHTM students are undertaking research to assess the performance of a tool to measure awareness of antibiotic resistance amongst prescribers and dispensers for human and animal health care. The research findings, from Peru, Nigeria, Ghana, Tanzania and Vietnam, will be pooled in psychometric analysis, with the aim of developing a final short validated tool that can be used to assess AMR Awareness across contexts.

The resulting tool is intended to inform efforts to design and evaluate interventions to address the first objective of the Global Action Plan on AMR, to raise awareness of AMR.