Tashkent, Uzbekistan (UzDaily.uz) — A regional study of antibiotic-prescribing practices among primary-care physicians in Kazakhstan, Kyrgyzstan, Uzbekistan, and Tajikistan found that more than a quarter of respondents were unfamiliar with delayed antibiotic prescribing, while many acknowledged prescribing antibiotics when patients requested them. The study included 369 doctors from Uzbekistan.
How much does a doctor's decision to prescribe an antibiotic depend solely on medical indications — and how much can the patient influence that decision?
The question is becoming increasingly important as bacterial resistance to antimicrobial drugs continues to grow.
A new regional study of primary healthcare physicians covered 1,231 doctors across four Central Asian countries: 469 in Kazakhstan, 274 in Kyrgyzstan, 369 in Uzbekistan, and 119 in Tajikistan. The findings were presented at the Second Regional One Health Conference in Bishkek.
The study, presented by Yuliya Semenova of Nazarbayev University's School of Medicine, examined physicians' awareness of antimicrobial resistance and their antibiotic-prescribing practices.
The issue has particular regional significance. Central Asian countries remain underrepresented in global antimicrobial-resistance data, while primary-care doctors make a substantial share of everyday decisions about antibiotic use.
Doctors Understand the Problem — but Practice Is More Complicated
Overall, most respondents recognized that their own antibiotic-prescribing practices could contribute to antimicrobial resistance in their regions.
But a gap remains between awareness of the problem and everyday clinical decisions.
One revealing finding concerns delayed antibiotic prescribing. Under this strategy, for certain conditions, a patient does not begin taking an antibiotic immediately. A doctor may instead recommend waiting and using the medication only if symptoms persist or worsen.
The study found that more than a quarter of the physicians surveyed were unfamiliar with the strategy.
There were differences among countries. According to the study's data, delayed prescribing was unfamiliar 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, roughly one in four Uzbek primary-care doctors participating in the survey was unfamiliar with this tool for more rational antibiotic use.
When the Patient Asks for an Antibiotic
Another finding concerns pressure from patients.
The study's authors noted that many physicians acknowledged prescribing antibiotics when patients themselves requested them.
That turns antimicrobial resistance from a purely medical issue into a communication problem as well.
A physician must not only determine whether an antibiotic is necessary but also explain to the patient why the medication may be ineffective or why unnecessary use can create risks in the future.
The study suggests that physicians are generally willing to discuss antimicrobial resistance with patients. Two factors, however, make those conversations more difficult: lack of time and the perception that patients are not interested in the issue.
Among respondents in Uzbekistan, 19 percent reported discussing antimicrobial resistance with patients “very often,” another 34.4 percent “often,” and 27.4 percent “sometimes.”
The problem, therefore, is not the complete absence of communication, but its consistency and quality — and whether physicians have sufficient time and tools for such conversations.
Clinical Guidelines Do Not Reach Everyone Equally
The study also examined physicians' use of clinical practice guidelines.
Among respondents from Uzbekistan, 43.9 percent said they frequently use clinical guidelines in their everyday practice, while another 29.5 percent said they use them sometimes. At the same time, 23.8 percent answered “rarely or never,” while 2.7 percent reported that good guidelines were unavailable. These figures are based on participants' self-reported practices.
For the authors, this represents one of the key areas in which the situation could be improved.
The study concludes that better access to high-quality clinical guidelines and additional professional training could contribute to more rational antibiotic prescribing in primary healthcare facilities across Central Asia.
Why the Results Should Not Be Treated as a Diagnosis of the Entire Health System
The study has important limitations.
Its cross-sectional design means it cannot establish cause-and-effect relationships. National sample sizes differed considerably, ranging from 469 participants in Kazakhstan to 119 in Tajikistan.
Participation was voluntary, and questionnaires were distributed using digital communication channels, potentially introducing selection bias.
Finally, researchers did not verify medical records or actual prescriptions: information about prescribing practices was self-reported by the physicians themselves.
The results therefore cannot automatically be generalized to all physicians in the four countries or interpreted as a precise estimate of inappropriate antibiotic prescribing.
They do, however, identify several potential areas for intervention: access to clinical guidelines, additional training, wider use of delayed prescribing, and better communication with patients.
Ultimately, the fight against antimicrobial resistance begins not only in the laboratory. It also begins with a doctor simply explaining why indiscriminate antibiotic use can be harmful.
