ArticleBMJ global health2023
Levels and determinants of overprescribing of antibiotics in the public and private primary care sectors in South Africa.
Article in BMJ global health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 32 citations in OpenAlex.
- National and regional challenges of antibiotic prescribing patterns in pediatric populations across Africa: a systematic review and meta-analysis.Systematic reviews · 2026Pooled it
- Improving antibiotic utilization in West Africa: enhancing interventions through systematic review and evidence synthesis.Antimicrobial resistance and infection control · 2025Pooled it
- Antibiotic prescribing practices and appropriateness of prescriptions in outpatient paediatric acute respiratory tract infections in Viet Nam.JAC-antimicrobial resistance · 2026Article
- The Applicability of AWaRe-Based Antibiotic Quality Indicators to Assess the Appropriateness of Antibiotic Prescribing in Primary Healthcare in South Africa: A Multicentre Point Prevalence Study and Implications for the Future.Antibiotics (Basel, Switzerland) · 2026Article
- Article
- Health workers' knowledge, perceptions, and practices relating to antimicrobial use and resistance in cross river state, Nigeria: a cross sectional study.Journal of health, population, and nutrition · 2026Article
- Development of AWaRe-Based Quality Indicators to Assess the Appropriateness of Antibiotic Prescribing in Primary Healthcare in South Africa.Antibiotics (Basel, Switzerland) · 2026Article
- Factors associated with inappropriate antibiotic use in South African communities: findings from the CAMUS survey.Frontiers in pharmacology · 2026Article
- Determining the Use and Reasons for Non-De-Escalation of Empiric Carbapenem Therapy in a Private Hospital in South Africa.Antibiotics (Basel, Switzerland) · 2025Article
- Antibiotic prescribing for outpatients with respiratory tract infections in public and private clinics of a resource-constrained setting, northern Ethiopia: a cross-sectional study.BMC infectious diseases · 2025Article
- Antibiotic dispensing practices in community pharmacies: Implications for antimicrobial stewardship in resource-constrained settings.Exploratory research in clinical and social pharmacy · 2025Article
- Current status and future direction of antimicrobial stewardship programs and antibiotic prescribing in primary care hospitals in Zambia.JAC-antimicrobial resistance · 2025Article
- Knowledge, Attitudes, and Practices of Iraqi Parents Regarding Antibiotic Use in Children and the Implications.Antibiotics (Basel, Switzerland) · 2025Article
- Status and implications of the knowledge, attitudes and practices towards AWaRe antibiotic use, resistance and stewardship among low- and middle-income countries.JAC-antimicrobial resistance · 2025Review
- Effectiveness and Safety of Dual Versus Triple Antibiotic Therapy for Treating Brucellosis Infection: A Retrospective Cohort Study.Antibiotics (Basel, Switzerland) · 2025Article
- Antimicrobial resistance, antibiotic prescribing practices and antimicrobial stewardship in South Africa: a scoping review.JAC-antimicrobial resistance · 2025Review
- Knowledge, Attitudes, Motivations, Expectations, and Systemic Factors Regarding Antimicrobial Use Amongst Community Members Seeking Care at the Primary Healthcare Level: A Scoping Review.Antibiotics (Basel, Switzerland) · 2025Review
- Unraveling brucellosis: advances in pathogenesis, diagnostic strategies, therapeutic innovations, and public health perspectives.Frontiers in medicine · 2025Review
- Provider perspectives on empirical antibiotic treatment for tuberculosis-like symptoms in South Africa's private general practice sector: A qualitative study in two cities.PLOS global public health · 2025Article
- Antibiotic prescribing in public primary healthcare centres in Maseru, Lesotho.Southern African journal of infectious diseases · 2025Article
Corrections and comments
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Authors and funding
2 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Although overprovision of antibiotics in primary care is a key driver of antibiotic resistance, little is known about its determinants in low-income and middle-income countries. Patient demand and financial incentives for providers are often held responsible for overprovision. Yet, inadequate provision exists in their absence and could be fuelled by quality of care issues and incorrect beliefs of providers regarding patients' expectations. We explored these issues in the private and public sector in South Africa, by conducting a cross-sectional study using standardised patients (SPs)-healthy individuals trained to portray a scripted clinical case to providers-presenting with symptoms of a viral respiratory infection in a sample of public and private sector clinics. We linked data from SP visits to rich survey data to compare the practices and their predictors in the two sectors. Unnecessary rates of antibiotics were similarly high in the public (78%) and private sector (67%), but private providers prescribed more antibiotics at higher risk of resistance development. In the private sector, overprescription of antibiotics diminished when consultations were more thorough, but increased for consultations scheduled later in the day, suggesting contrasting effects for provider effort and decision fatigue. We observed differences in beliefs that could be responsible for overprescription: in the public sector, a majority of providers (nurses) wrongly believed that antibiotics would help the patient recover more quickly. In the private sector, a majority of doctors thought patients would not come back if they did not receive antibiotics. Overall, this evidence suggests that different factors may be responsible for the high overprescribing rates of antibiotics in the public and private sectors. Tailored stewardship interventions are urgently needed that tackle providers' engrained habits and incorrect beliefs.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.