Tsegaye Melaku and Lidia Assegid’s article, Prescription in Peril: The Sociology of Antibiotics and Antimicrobial Resistance in Low-Resource Settings, presents a timely and critical examination of the escalating threat of antimicrobial resistance (AMR) from a sociological perspective. The authors highlight that AMR, if left unaddressed, could result in an estimated 10 million deaths annually by 2050, with low- and middle-income countries (LMICs) disproportionately affected due to AMR rates three to four times higher than those in high-income countries.
While biological mechanisms—such as genetic mutation and horizontal gene transfer—form the foundation of AMR development, Melaku and Assegid underscore the necessity of examining the equally influential yet underexplored sociological drivers. The sociology of antibiotics, as defined by the authors, encompasses the complex interaction between social, cultural, behavioral, economic, and political factors that shape how antibiotics are prescribed, consumed, and distributed in communities. These social dimensions critically influence both the emergence and persistence of AMR.
Drawing on a range of empirical observations from LMICs, the article illustrates how health beliefs, prescribing behaviors, pharmaceutical supply chains, and systemic health governance weaknesses converge to facilitate irrational antibiotic use. Factors such as poverty, health illiteracy, informal drug markets, and limited access to regulated healthcare significantly impede stewardship efforts. The widespread availability of antibiotics without prescriptions, combined with the economic necessity to self-medicate using incomplete or substandard treatments, fuels inappropriate consumption patterns.
To analyze these dynamics, the authors apply two key sociological frameworks:
- Actor-Network Theory (ANT): ANT conceptualizes AMR as emerging within an intricate network of human and non-human actors—including microbes, prescribers, pharmaceutical companies, and policy frameworks—each influencing resistance patterns through interdependent roles and relationships.
- Social Constructionism: This approach emphasizes how cultural meanings, historical experiences, and political power structures shape public perceptions of antibiotics and institutional responses to AMR. It challenges the notion of AMR as a purely biomedical issue by situating it within specific socio-cultural and historical contexts.
Furthermore, the article incorporates the One Health framework, emphasizing the interconnectedness of human, animal, and environmental health. This approach is particularly salient in LMICs where regulatory infrastructures are often weak, and interspecies microbial exchange is frequent. The authors argue that the sociological lens enables a more nuanced understanding of how veterinarians, farmers, community health workers, and patients make antibiotic-related decisions influenced by local beliefs, economic pressures, and institutional trust.
Ultimately, Melaku and Assegid advocate for context-sensitive, community-based interventions that integrate both biological and sociological strategies. They call for interdisciplinary stewardship initiatives that involve not only clinicians and scientists but also sociologists, anthropologists, and community leaders. These interventions must prioritize health education, localized awareness campaigns, and the strengthening of community health systems. The article concludes with a call for a holistic, multi-sectoral response to AMR that addresses the underlying social determinants of antibiotic misuse in resource-constrained environments.
Reference: Melaku, T., & Assegid, L. (2025). Prescription in peril: The sociology of antibiotics and antimicrobial resistance in low resource settings. Discover Social Science and Health, 5(71). https://doi.org/10.1007/s44155-025-00225-1
Here are the five most important concepts from the provided article, along with their detailed definitions:
- Antimicrobial Resistance (AMR): AMR represents a significant and escalating threat to global public health, particularly severe in low-resource settings where access to proper healthcare and medication is often limited. If left unaddressed, AMR is estimated to cause 10 million deaths annually worldwide by 2050. Low- and middle-income countries (LMICs) face disproportionately high rates, experiencing resistance 3–4 times higher than high-income countries. While biological factors like genetic mutations and horizontal gene transfer are fundamental drivers, sociological forces also play a substantial role in its emergence and spread.
- Sociology of Antibiotics: This concept delves into the intricate interplay between social, cultural, behavioral, political, and economic factors that contribute to antimicrobial resistance (AMR). It highlights that how antibiotics are prescribed, consumed, and shared within communities reflects broader social practices. The article emphasizes that this sociological aspect of antibiotic use and access in low-resource settings is often overlooked. It specifically examines how elements like patient health beliefs, provider prescribing practices, pharmaceutical supply chains, and broader health system weaknesses converge to drive inappropriate antibiotic consumption. Furthermore, social disparities, poverty, limited health literacy, and the shadow economy of unregulated drug markets undermine efforts for responsible antibiotic use.
- Low-Resource Settings (LRS) / Low- and Middle-Income Countries (LMICs): These refer to regions or communities where the threat of AMR is particularly intensified. These settings often have limited access to appropriate healthcare and quality medications, and the intersection of poverty creates an environment conducive to the misuse of antibiotics and the widespread dissemination of AMR. In such communities, financial barriers frequently lead to practices like self-medication, incomplete antibiotic courses, or the use of substandard medications. Other contributing factors include a lack of affordable diagnostic tools resulting in empirical antibiotic prescribing, poor sanitation, and inadequate infection control measures. LMICs globally experience alarmingly high rates of AMR, significantly exceeding those in high-income countries.
- One Health Approach: This is a crucial interconnected perspective that recognizes the inseparable links between human health, animal health, and our shared environment. Within the context of AMR, this approach acknowledges that resistant microbes can spread across these three domains. Its relevance is particularly heightened in low-resource settings, where close contact between humans and animals may be common, and environmental regulations might be less stringent, thereby facilitating the spread of resistance. From a sociological standpoint, the One Health approach helps stewardship programs understand how diverse stakeholders—including physicians, veterinarians, farmers, and consumers—make decisions about antibiotic use influenced by their social contexts, professional norms, and economic pressures. Effective communication across these sectors is essential for combating AMR effectively.
- Community-Based Interventions: These are localized, grassroots strategies designed to address the complex sociocultural drivers of AMR directly within low-resource communities. Instead of a one-size-fits-all solution, these interventions are tailored to the unique knowledge, needs, and resources of individual communities, considering their diverse cultural contexts, healthcare infrastructure, and socioeconomic realities. They aim to foster sustained behavioral changes and long-term ownership of AMR solutions by actively engaging the communities themselves. Key examples include:
- Public education and awareness campaigns that involve community and religious leaders and local media, with messaging tailored to cultural beliefs.
- Strengthening community-based healthcare access through programs like community health workers and quality-assured pharmacies.
- Fostering community-driven antibiotic stewardship by engaging local leaders and traditional healers to champion responsible antibiotic use.
- Enhancing community-level disease surveillance by empowering community health workers to collect and report data on infectious diseases and antibiotic use.
- Promoting community-based research and innovation to understand local drivers of misuse and explore culturally appropriate strategies for managing infectious diseases. Ultimately, these interventions are vital for a holistic strategy that integrates both biological and sociological approaches to preserve the effectiveness of antibiotics.