Know hole and know-do hole in antibiotics prescribing for little one diarrhea. Credit score: Science Advances (2025). DOI: 10.1126/sciadv.ady9868
Researchers from USC and Duke report in Science Advances that the persistent “know-do gap”—the place clinicians know pointers however observe in another way—is the first driver of antibiotic overprescribing for pediatric diarrhea in India’s non-public sector, not lack of expertise, point-of-sale income, or stockouts of clinically advisable remedies corresponding to oral rehydration salts (ORS).
In a pattern of two,282 non-public suppliers throughout 253 cities, 70% prescribed antibiotics with out indicators of bacterial an infection, and amongst those that knew antibiotics have been inappropriate, 62% nonetheless prescribed them to standardized sufferers, indicating a big know-do hole. The examine discovered that eliminating the information hole alone would lower inappropriate antibiotic use by about 6 share factors, whereas closing the know-do hole may scale back it by roughly 30 share factors.
Randomized experiments confirmed that the know-do hole was pushed by suppliers’ beliefs about affected person preferences and never income from promoting antibiotics or restricted provides of ORS. When sufferers expressed a choice for ORS, inappropriate antibiotic use fell by 17 share factors on common, with particularly massive reductions amongst pharmacies. Against this, eradicating point-of-sale monetary incentives and supplying ORS had no significant impact on antibiotic prescribing.
A discrete selection experiment with 1,189 caregivers additional discovered that sufferers didn’t choose suppliers who give antibiotics over those that present ORS, underscoring the misalignment between supplier perceptions and precise affected person preferences.
“Our data reveal a striking disconnect: clinicians know antibiotics are wrong for most diarrhea cases, yet prescribe them anyway because they think parents expect ‘strong’ medicines,” mentioned corresponding creator Zachary Wagner of USC’s Heart for Financial and Social Analysis. “Correcting that perception, rather than another training seminar, offers the biggest win for global antibiotic stewardship.”
“A lot of children are given antibiotics when they don’t need them, and that can lead to drug-resistant bacteria—a problem for the whole world, not just India. By showing that patient–provider communication trumps financial motives, we give policymakers a laser-focused lever: help doctors understand real patient preferences,” added co-author Neeraj Sood of the USC Schaeffer Heart and Value College.
The authors be aware the biggest know-do gaps amongst much less formally educated suppliers and pharmacies, the place choice signaling by sufferers yielded the most important enhancements, suggesting focused interventions may ship outsized advantages.
“Pharmacies and informal providers, often the first stop for care, showed the largest know-do gaps,” famous Manoj Mohanan of Duke College. “Interventions that empower caregivers to voice a preference for ORS, or public campaigns signaling that parents don’t demand antibiotics, could slash misuse at scale.”
Extra info:
Zachary Wagner et al, Investigating the know-do hole in antibiotics prescribing: Experimental proof from India, Science Advances (2025). DOI: 10.1126/sciadv.ady9868
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Duke College
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Supplier misperceptions drive inappropriate antibiotic overprescribing for little one diarrhea in India, finds examine (2025, September 23)
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