As part of a regional study on the practice of primary care physicians prescribing antibiotics in Kazakhstan, Kyrgyzstan, Uzbekistan, and Tajikistan, it was found that more than a quarter of respondents were unaware of the delayed antibiotic prescription strategy, while many admitted to prescribing medications upon patient demand.
The question of how much a doctor's decision to prescribe an antibiotic depends solely on medical indications and what role the patient plays in this is becoming increasingly relevant against the backdrop of growing bacterial resistance to antimicrobial drugs.
The new regional study covered 1231 doctors from four Central Asian countries: 469 from Kazakhstan, 274 from Kyrgyzstan, 369 from Uzbekistan, and 119 from Tajikistan. The results were presented at the Second Regional Conference on the 'One Health' concept in Bishkek.
The study, conducted by Yulia Semenova from Nazarbayev University Medical School, analyzed doctors' awareness of the problem of antimicrobial resistance and their methods of prescribing antibiotics. This issue has particular regional significance because Central Asian countries are underrepresented in global data on antimicrobial resistance, while primary care physicians make a significant portion of daily decisions regarding antibiotic use.
Doctors understand the problem, but practice is more complex
Overall, most participants admitted that their own antibiotic prescribing practices might contribute to the development of antimicrobial resistance in their regions. However, there remains a gap between awareness of the problem and daily clinical decisions.
Particular attention was drawn to the study of delayed antibiotic prescription. With this tactic, for certain conditions, the patient does not start taking antibiotics immediately; the doctor may advise waiting and using the medication only if symptoms persist or worsen. The study showed that more than a quarter of the surveyed doctors were unfamiliar with this strategy.
There were differences between countries: according to the study, delayed prescription was unknown to 26.2 percent of respondents in Kazakhstan, 30.7 percent in Kyrgyzstan, 25.2 percent in Uzbekistan, and 27.7 percent in Tajikistan. In other words, approximately one in four primary care physicians in Uzbekistan participating in the survey did not know about this tool for more rational antibiotic use.
When the patient asks for antibiotics
Another finding concerns pressure from patients. The study authors noted that many doctors admitted to prescribing antibiotics when patients themselves requested them. This turns antimicrobial resistance from a purely medical problem into a communication one.
A doctor must not only determine the need for an antibiotic but also explain to the patient why the medication may be ineffective or why unnecessary use could create future risks. The study suggests that doctors are generally willing to discuss antimicrobial resistance with patients. Nevertheless, two factors complicate these conversations: lack of time and the belief that patients are not interested in the topic.
Among respondents from Uzbekistan, 19 percent reported discussing antimicrobial resistance with patients 'very often,' another 34.4 percent 'often,' and 27.4 percent 'sometimes.' Thus, the problem is not a complete absence of communication, but rather its consistency and quality—as well as the availability of sufficient time and tools for such discussions by doctors.
Clinical guidelines are not reaching everyone equally
The study also examined the use of clinical guidelines by doctors. Among respondents from Uzbekistan, 43.9 percent stated that they frequently use clinical guidelines in their daily work, while another 29.5 percent said they use them sometimes. Furthermore, 23.8 percent answered 'rarely or never,' and 2.7 percent reported that good guidelines were unavailable. These figures are based on the self-reported practices of the participants.
For the authors, this represents one of the key areas where the situation can be improved. The study concludes that better access to high-quality clinical guidelines and additional professional training can promote more rational antibiotic prescribing in primary healthcare institutions across Central Asia.
Why the results should not be considered a diagnosis of the entire healthcare system
The study has several limitations. Its cross-sectional design does not allow for establishing cause-and-effect relationships. National sample sizes varied significantly, ranging from 469 participants in Kazakhstan to 119 in Tajikistan. Participation was voluntary, and questionnaires were distributed through digital communication channels, which could potentially cause sample bias. Finally, researchers did not check medical records or actual prescriptions: information on prescribing practices was provided by the doctors themselves.
Therefore, the results cannot be automatically generalized to all doctors in the four countries or interpreted as an accurate assessment of improper antibiotic prescribing. However, they point to several potential areas for intervention: access to clinical guidelines, additional training, wider application of delayed prescription, and improved patient communication. Ultimately, the fight against antimicrobial resistance begins not only in the laboratory but also with a simple explanation from the doctor about why uncontrolled antibiotic use can be harmful.