Investigating the know-do gap in antibiotics prescribing: Experimental evidence from India

Antimicrobial resistance is largely driven by overuse of antibiotics, which is particularly common in low- and middle-income countries. We combine provider knowledge assessments and over 2000 anonymous standardized patient visits to providers in India to examine why they overprescribe antibiotics for pediatric diarrhea and figure out how to reduce overprescribing. Seventy percent of providers prescribed antibiotics without indication of bacterial infection. Knowledge gaps explain little: 62% of providers who knew antibiotics were inappropriate still prescribed them. Closing this "know-do gap" would reduce prescribing by 30 percentage points, versus only 6 points if all providers had perfect knowledge. Using randomized experiments, we revealed that the know-do gap stems from providers' beliefs that patients want antibiotics, not from profit motives or lack of alternative treatments. Yet, a discrete choice experiment suggests patients do not prefer providers who give antibiotics. Our findings indicate that addressing provider misperceptions about patient preferences may be more effective than standard information-based interventions in reducing antibiotic overuse.