Antibiotic dispensing practices and determinants among informal healthcare providers in low- and middle-income countries: a mixed-methods scoping review

作者：M V Pai, Poshan Thapa, Giorgia Sulis, Charity Oga-Omenka, Buna Bhandari, Sumanth Gandra, Geneviève Gore, Surbhi Sheokand, Prachi Shukla, Meera Tandan, Diwash Timalsina, Shweta Bohora, Swostika Thapaliya, Anupama Bhusal, Chandrashekhar Joshi, Md Asadullah, Mili Dutta, Samira Abbasgholizadeh Rahimi · 发表于：DOAJ (DOAJ: Directory of Open Access Journals) · 年份：2026 · DOI：10.1136/bmjgh-2025-023208 · 被引用次数：1 · 研究领域：Antibiotic Use and Resistance、Pharmaceutical and Antibiotic Environmental Impacts、Antibiotic Resistance in Bacteria

Introduction Antimicrobial stewardship efforts in low- and middle-income countries (LMICs) largely focus on qualified practitioners, yet informal healthcare providers (IPs) deliver much of the primary care. Although these providers frequently dispense antibiotics, their practices remain poorly documented and are not captured in existing surveillance systems.Methods Using the Joanna Briggs Institute methodology, this scoping review synthesised evidence on antibiotic dispensing and its determinants among IPs in LMICs. Nine databases (MEDLINE, EMBASE, SCOPUS, Global Health, CINAHL, Web of Science, LILACS, African Journals Online via Africa-Wide Information and Index Medicus for the South-East Asia Region) were searched, yielding 12 095 records, of which 37 studies met the inclusion criteria.Results Across 31 studies reporting dispensing practices, antibiotic use by IPs varied widely: 18%–74% in studies using standardised methods, 5%–96% in provider-reported studies and 2%–86% in consumer-reported studies. Eight qualitative studies identified key behavioural and contextual determinants shaping dispensing, including limited knowledge, experience-based learning, patient expectations, peer and pharmaceutical influence, perceived consequences of withholding antibiotics and economic incentives.Conclusion Antibiotic dispensing by IPs is widespread and represents a large but unmeasured component of antibiotic use in LMICs. These findings highlight a critical gap in antimicrobial resista...