CONTEXT: Antimicrobial resistance is a serious public health concern worldwide. Inappropriate prescribing, including the wrong drug, incorrect dose/duration, and poor compliance, contributes to it. OBJECTIVE: To identify factors determining the attitudes and practices of prescribers regarding antibiotic usage and to suggest measures that contain antibiotic resistance. DESIGN AND SETTING: With a convenient sample, general practitioners and specialists of both sexes from 5 districts of Tamilnadu state, India, were approached for the study. A slightly modified, self-administered, anonymous questionnaire of the Alliance for the Prudent Use of Antibiotics was used. The deciding factors to prescribe an antibiotic and the reasons for the attitude to prescribe a broad-spectrum antibiotic were elicited. RESULTS: Out of the 285 participants 120, 110, and 47 practiced at city, semiurban, and rural areas, respectively. The responses were graded with a total possible score of 150. There was no significant difference between men and women or between specialist and nonspecialists in scores. The majority believed that antibiotics are overprescribed. Purulent discharge (65%), antibiotic-resistance concerns (48%), fever (40%), and patient satisfaction (29%) were the strong influences to prescribe an antibiotic. Similar reasons were cited for the belief of prescribing a broad-spectrum antibiotic. The 3 most commonly prescribed antimicrobials were amoxicillin (21%), ciprofloxacin (18%), and co-trimoxazole (11%). About 42% used an antibiogram only to the extent of less than 10%. CONCLUSION: Patient requests/expectations, patient satisfaction, purulent discharge, and fever strongly pressurized practitioners to prescribe antibiotics. Patient and time pressures, diagnostic and treatment uncertainties, and the poor utilization and/or ill-affordable antibiogram facility all point to an urgent, multidimensional approach to contain antibiotic resistance.
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