Open Access Highly Accessed Research article

Antibiotic use, resistance development and environmental factors: a qualitative study among healthcare professionals in Orissa, India

Krushna Chandra Sahoo1, A J Tamhankar23, Eva Johansson14 and Cecilia Stålsby Lundborg1*

Author Affiliations

1 Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Nobels väg 9, SE 171 77 Stockholm, Sweden

2 Department of Environmental Medicine, R.D. Gardi Medical College, Ujjain 456 006, India

3 Indian Initiative for Management of Antibiotic Resistance (IIMAR), N.G. Acharya & D.K. Marathe College, Chembur, Mumbai, 400 071, India

4 The Nordic School of Public Health, Gothenburg, Sweden

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BMC Public Health 2010, 10:629  doi:10.1186/1471-2458-10-629

Published: 21 October 2010



Antibiotic resistance is a major public health problem affecting both current and future generations. The influence of environmental factors on antibiotic use and resistance development in bacteria is largely unknown. This study explored the perceptions of healthcare providers on antibiotic use and resistance development in relation to environmental factors i.e. physical, natural, social and behavioural factors.


A qualitative interview study was conducted using face-to-face, semi-structured interviews among registered allopathic doctors, veterinarians and drug dispensers in Orissa, India. The interview transcripts were analyzed using latent content analysis.


The main findings of this study relate to two themes: 'Interrelationship between antibiotic use, resistance development and environment' and 'Antibiotic management contributing to the development and spread of resistance'. The interviewees viewed the following as possible contributors to antibiotic use/misuse and resistance development: changes in the natural and physical environment i.e. climate variability, pollution, physiography and population growth; the socioeconomic environment affecting health-seeking behaviour and noncompliance with medication; a lack of healthcare facilities and poor professional attitudes; and ineffective law enforcement regarding medicine dispensing and disposal.


Generally, the interviewees perceived that although behavioural and social environmental factors are major contributors to resistance development, changes in the physical and natural environment also influence development of antibiotic resistance. The respondents also perceived that there is a lack of information about, and poor awareness of, what constitutes prudent use of antibiotics. They suggested a need for information, education, dissemination and proper implementation and enforcement of legislation at all levels of the drug delivery and disposal system in order to improve antibiotic use and prevent pharmaceutical contamination of the environment.