This paper explores the socio cultural and institutional determinants of irresponsible prescription and use of antibiotics which has implications for the rise and spread of antimicrobial resistance (AMR). This study describes the patterns of prescription of antibiotics in a public facility in India and identifies the underlying institutional, cultural and social determinants driving the irresponsible use of antibiotics. The analysis is based on an empirical investigation of patients’ prescriptions that reach the in-house pharmacy following an outpatient department (OPD) encounter with the clinician. The prescription analysis describes the factors associated with use of broad-spectrum antibiotics, and a high percentage of prescriptions for dental outpatient department prescribed as a precautionary measure. This paper further highlights the need for future research insights in combining socio-cultural approach with medical rationalities, to further explore questions our analysis highlights like higher antibiotic prescription, etc., Along with the recommendations for further research.

Antimicrobial Resistance (AMR) is one of society’s most urgent global issues, requiring urgent multidisciplinary-based research and practice approaches to engage with these policies. Several global and national policy statements have been released in the last two decades, particularly emphasising the strengthening of the digital surveillance system. However, implementing these initiatives remains patchy, particularly in the context of public health systems in Low- and Middle-Income Countries. This paper argues that one of the significant reasons contributing to this sub-optimal uptake of these systems is that the top-down implementation models do not adequately cater to the needs, aspirations, and capacities of the health facility staff, who, ultimately, are the end users of the system. The paper highlights the importance of digital technology in healthcare facilities with resource constraints to promote the responsible use of antibiotics. It discusses the process of developing an evidence base for action in low- and middle-income countries (LMICs) through digitally mediated data-driven policy. This process is conceptualised as a three-phase process, which involves stabilising data entry, generating outcomes, and taking action at the local level. The paper argues the need for bottom-up implementation models, which emphasise the need to understand the practices users engage with in their everyday work and design the digital system to add value and not work to these everyday practices. The paper emphasises the importance of building local capacities to develop effective and sustainable antimicrobial stewardship (AMS) programs through enabling networking around digital solutions, creating value in networked partnerships, initiating conversations around data, and raising awareness of the digital to develop AMS programs.

Antimicrobial resistance (AMR) is a tremendous contemporary challenge, described by the former secretary-general of the World Health Organization (WHO), M Chan as a “slow-moving tsunami” threatening “the end of modern medicine as we know it” [1]. AMR has multi-faceted adverse consequences spanning human and animal health, economics, climate, and environment, endangering the future of societies […]

This paper introduces a comprehensive framework that elucidates the microfoundations of data-driven antimicrobial stewardship programs (ASPs), specifically focusing on resource-constrained settings. Such settings necessitate the utilization of available resources and engagement among multiple stakeholders. The microfoundations are conceptualized as interlinked components: input, process, output, and outcome. Collectively, these components provide a comprehensive framework for understanding the development and implementation of data-driven ASPs in resource-constrained settings. It underscores the importance of considering both the social and material dimensions when evaluating microbiological, clinical, and social impacts. By harmonizing technology, practices, values, and behaviors, this framework offers valuable insights for the development, implementation, and assessment of ASPs tailored to resource-constrained environments.

Antibiotic resistance (ABR) presents a widespread, complex threat to global health and achieving universal health coverage. A key global and national priority set to address this challenge focuses on creating a digitally enabled evidence base to make visible this problem and strengthen policy and practice interventions. The invisibility of the ABR problem is particularly acute in low and middle-income settings, where digitization in this domain is in its infancy and there is a high prevalence of infections and severe constraints of capacity and infrastructure. The focus of this paper is to explore how a digital ABR reporting system can be introduced, routinized, and stabilized in such a context that the ABR challenge can be better managed. The paper combines IS concepts from requirement analysis and implementation research together with concepts from institutional theory, to develop an analytical framework that makes the following contributions: 1) How can new practices relating to a digital intervention be routinized into everyday work; 2) How can these routinized practices be translated into stabilized institutional work to ensure their sustainability over time; and 3) What is the work required to bridge the gaps between the formal institutions that accompany the new digital system and the informal constraints that are experienced in implementing them.