Doctor Protecting Community from Antibiotic Resistance

The Silent Pandemic: Unpacking Antibiotic Resistance in South African Primary Care

Lena Voss in Health & Wellness June 2025 • 4 min read.

"A deep dive into how knowledge, attitudes, and perceptions of ABR among prescribers could be the key to curbing its spread."

Antibiotic resistance (ABR) represents a significant threat to global health, jeopardizing our ability to treat common infections. In South Africa, as in many other parts of the world, the inappropriate use of antibiotics in primary care settings is a major driver of this resistance. Understanding the knowledge, attitudes, and perceptions of healthcare providers who prescribe these medications is crucial for developing effective strategies to promote responsible antibiotic use.

A recent study delved into the minds of South African primary care prescribers to assess their understanding of ABR, their attitudes towards prescribing practices, and their perceptions of patient expectations and other influencing factors. The findings offer valuable insights into the complexities of antibiotic stewardship in this specific context.

This article breaks down the key findings of this research, exploring the challenges and opportunities for improving antibiotic prescribing practices in South Africa. By understanding the perspectives of those on the front lines of healthcare, we can work towards more effective interventions to combat the growing threat of antibiotic resistance and protect public health.

Decoding Prescriber Perceptions: Knowledge vs. Pressure

Doctor Protecting Community from Antibiotic Resistance

The study, which surveyed a diverse group of primary healthcare providers in South Africa, revealed a complex landscape of knowledge, attitudes, and perceptions surrounding ABR. A significant majority (95.8%) of prescribers recognized ABR as a major problem in South Africa. However, a concerning 66.5% reported feeling pressure from patients to prescribe antibiotics, even when they didn't believe they were necessary. This highlights a key tension between prescribers' awareness of the ABR issue and the perceived need to satisfy patient demands.

While most prescribers acknowledged the threat of ABR, their actual knowledge of antibiotic use varied. The median knowledge score was 5 out of 7, indicating room for improvement in understanding optimal prescribing practices. Interestingly, prescribers under the age of 55 demonstrated higher knowledge scores compared to their older counterparts, potentially reflecting differences in medical training and ongoing education.

Narrow-spectrum antibiotics: Those with higher knowledge scores were more likely to favor narrow-spectrum antibiotics over broad-spectrum options when appropriate (adjusted odds ratio (aOR) 1.29, 95% confidence interval (CI) 1 - 1.65).
Patient education: They were also more inclined to explain disease features that should prompt follow-up as an alternative to prescribing antibiotics (aOR 1.47, 95% CI 1.058 - 2.04).
Avoiding unnecessary prescriptions: Notably, they were less likely to believe that antibiotics are harmless even when not needed, and therefore less likely to prescribe them unnecessarily (aOR 0.57, 95% CI 0.38 - 0.84).

These findings suggest that increasing prescribers' knowledge about antibiotics and ABR can positively influence their prescribing behaviors, leading to more judicious use of these essential medications.

Empowering Prescribers: Education and Beyond

The study underscores the need for ongoing education and support for primary care prescribers in South Africa. By equipping them with the knowledge and tools to make informed prescribing decisions, we can empower them to resist patient pressure and prioritize responsible antibiotic use. Further interventions should focus on improving communication strategies to address patient expectations, promoting the use of narrow-spectrum antibiotics when appropriate, and ensuring access to diagnostic tests to guide treatment decisions. Ultimately, a multi-faceted approach is essential to tackling the complex challenge of antibiotic resistance and safeguarding the effectiveness of these life-saving medications for future generations.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.7196/samj.2018.v108i9.12933, Alternate LINK

Title: Antibiotic Use And Resistance: Knowledge, Attitudes And Perceptions Among Primary Care Prescribers In South Africa

Subject: General Medicine

Journal: South African Medical Journal

Publisher: South African Medical Association NPC

Authors: E Farley, A Stewart, M-A Davies, M Govind, D Van Den Bergh, T H Boyles

Published: 2018-08-28

Everything You Need To Know

What exactly is antibiotic resistance (ABR), and why is it such a big problem?

Antibiotic resistance (ABR) is a growing global health crisis where antibiotics become ineffective against infections. Inappropriate antibiotic use in primary care settings is a significant driver of ABR. The implications of ABR include the inability to treat common infections, potentially leading to prolonged illness, increased healthcare costs, and even fatalities. The article highlights the importance of understanding prescribers' knowledge, attitudes, and perceptions to combat ABR.

What was the focus of the study mentioned and why is this important?

The study focused on primary care prescribers in South Africa to assess their understanding and practices related to Antibiotic resistance (ABR). This is significant because inappropriate antibiotic use is a major driver of ABR. The study explores prescribers' knowledge, attitudes, and perceptions to identify opportunities for interventions. This helps in developing effective strategies to promote responsible antibiotic use and protect public health.

What challenges do prescribers face when it comes to antibiotic use?

The study found that a significant majority of prescribers recognized Antibiotic resistance (ABR) as a major problem, but many felt pressured by patients to prescribe antibiotics. This reveals a conflict between awareness of ABR and the perceived need to satisfy patient demands. Addressing this pressure is crucial for promoting responsible antibiotic use and preventing the spread of ABR. This pressure can lead to unnecessary prescriptions, contributing to the development of resistant bacteria.

How does a prescriber's knowledge impact their prescribing habits?

The findings indicated that prescribers under 55 demonstrated higher knowledge scores about Antibiotic resistance (ABR) compared to their older counterparts. Those with higher knowledge favored narrow-spectrum antibiotics, were more likely to educate patients, and less likely to prescribe antibiotics unnecessarily. This suggests that education and training play a significant role in shaping prescribing behaviors. It also underscores the importance of ongoing education to improve understanding of optimal prescribing practices and promote responsible antibiotic use.

What steps can be taken to improve antibiotic prescribing practices?

The article highlights the need for ongoing education and support for primary care prescribers in South Africa to address Antibiotic resistance (ABR). This includes improving their knowledge of antibiotics, equipping them with tools to make informed decisions, and developing communication strategies to manage patient expectations. It also suggests promoting the use of narrow-spectrum antibiotics when appropriate, and ensuring access to diagnostic tests. These interventions aim to promote responsible antibiotic use and protect public health by combating the growing threat of antibiotic resistance.