A qualitative study of the influence of childcare on high antibiotic use in a multicultural, lower socioeconomic community

The determinants of high use of antibiotics in childcare in a multicultural community are multifactorial, inter-related and complex. The two interacting themes, cultural factors and regulatory/administrative environment, appear to capture these determinants. The study did not find evidence of explicit pressure on parents to obtain antibiotics for children. However, the themes described appear to work together to increase antibiotic prescriptions. Parents and care providers expressed beliefs in antibiotic efficacy for numerous conditions, contrary to scientific knowledge and public health messaging. Respondents were not aware that antibiotic use in the region is unusually high. The regulatory and administrative context determining childcare attendance during illness does not seem to overtly drive antibiotic seeking behaviour. However, parents expressed an imperative to work which appeared to drive adoption of strategies perceived to shorten illness, including using antibiotics. These factors may also increase doctor attendance seeking certificates to facilitate early return to childcare. Doctor attendance may increase antibiotic prescriptions. These issues deserve further investigation which should also include doctors' perspectives.