Improvisation, therapeutic brokerage and antibiotic (mis)use in India: a qualitative interview study of Hyderabadi physicians and pharmacists.

Antimicrobial resistance (AMR) is widely reported to be a rapidly escalating global health threat. Investigations into the social dimensions of AMR have tended to focus on economically wealthier nations, even though economically poorer countries are a site of considerable and often increasing antibiotic (mis)use. Understanding the global and local dynamics of antibiotic resistance, we propose, requires critical sociological investigation at the nexus of economic development, structural constraints, cultural norms, and infection-management practice. Here, to begin to unpack these intersections, we draw on qualitative interviews with physicians and pharmacists in Hyderabad to explore their accounts of the social dynamics of AMR in India. In particular, we focus on their accounts of practices of improvisation and self-medication with antibiotics; the nexus of informal and formal pharmaceutical economies and the vested interests therein; and the everyday brokering of antibiotics. We posit that responses to AMR need to be deeply embedded in the specificities of everyday practice, local market forces, and regulatory (im)possibilities with attention paid to the locally prevailing cultural norms. [ABSTRACT FROM AUTHOR]