Rationality and Resistance: A Study on Antibiotic Prescription Practices Among General Practitioners in Rural Bangladesh

Background: In rural Bangladesh, antibiotic misuse by unlicensed healthcare providers (“quack doctors”) is a growing contributor to antimicrobial resistance. This study aimed to assess the rationality of antibiotic prescriptions and identify factors influencing irrational use among rural patients. Methods: A cross-sectional study was conducted from January to June 2024 at Sir Salimullah Medical College Hospital, Dhaka. Data were collected from 230 rural patients who had previously received antibiotics from quack doctors. Structured interviews captured demographic details, presenting symptoms, prescribed antibiotics, and any prior investigations. Rationality was assessed based on national and WHO guidelines. Logistic regression was used to identify factors associated with irrational prescribing. Results: The most common symptoms were fever (59.1%), respiratory tract infections (39.6%), and urinary tract infections (21.3%). The most frequently prescribed antibiotics were cefixime (49.6%), cefuroxime (25.2%), and ciprofloxacin (22.6%). Only 27.4% of prescriptions were rational, while 50.4% were classified as irrational. Notably, 90.0% of patients received antibiotics without any laboratory or microbiological investigations. Logistic regression showed that respiratory symptoms (aOR = 2.21, p = 0.011), absence of diagnostic testing (aOR = 4.53, p < 0.001), and patient demand (aOR = 2.79, p = 0.002) significantly increased the likelihood of irrational prescribing. Conclusion: Antibiotic prescribing by informal practitioners in rural Bangladesh is largely irrational and empirical, contributing to antibiotic resistance. Strengthening diagnostic capacity, regulating antibiotic sales, and implementing community-level antibiotic stewardship are urgently needed to combat this public health threat.