Antimicrobial resistance as a social dilemma: Approaches to reducing broad-spectrum antibiotic use in acute medical patients internationally


Timescale: January 2017 - December 2018

Funder: Research Councils' Tackling AMR Initiative



AntibioticsAntimicrobial resistance is one of the largest and most widely acknowledged problems in 21st century medicine. The prescription of antibiotics is influenced by many social, cultural and organisational factors, and those prescribing antibiotics have to balance competing interests, values and short and long term benefits when making decisions. Healthcare providers have a responsibility both to individual patients and to "society at large", and since there is often not a "technical" solution to problems with prescribing, decisions are usually based on moral values and the customs of the healthcare community. Therefore attempts to change the ways antibiotics are prescribed will be more effective if they take these social factors into account. These social factors, and thus decisions made by individuals about prescribing antibiotics, are strongly influenced by the local and national context.

Project aims

  • To develop an international group of academics and clinicians who will work together to use social science theory and methods to look at the use of antibiotics in treating seriously ill patients
  • To build a model which identifies the risks, tensions, and elements of social and cultural context that effect the way broad spectrum antibiotics are prescribed, and use this to find ways to improve antibiotic prescribing
  • To explore the application of agent-based modelling approaches to predicting prescribing behaviour in communities of practitioners in different contexts; this approach may help identify which actions have the best chance of success in different contexts, particularly in non-high income countries.

The research study

The project will compare attitudes to prescribing antibiotics in England, Sri Lanka, and South Africa. We will conduct interviews with around 10-12 key informants involved in the prescribing pathway for acute medical patients in each country. Key informants will be purposively selected to ensure diversity in terms of role, and in terms of insight into particular contextual influences and challenges in the pathway. Researchers will interpret the data using theoretical literature on social dilemmas, behavioural game theory, and principal-agent theory, and applied literature on the application of these theoretical approached to healthcare provision and prescribing. The study will also involve training local researchers in Sri Lanka and South Africa in interviewing skills and will lay the ground work for future international collaborations.

Research Team

Dr Carolyn Tarrant (PI)
Prof Andrew Colman Dr Edmund Chattoe-Brown Dr David Jenkins
Dr Nelun Perera (Sri Lanka lead) Prof Shaheen Mehtar (South Africa lead) Dr Eva Krockow (researcher)


  • Fitzpatrick F, Tarrant C, Hamilton V, Kiernan FM, Jenkins D, Krockow EM. Sepsis and antimicrobial stewardship: two sides of the same coin. BMJ Qual Saf. 2019 Apr 24:
  • Colman AM, Krockow EM, Chattoe-Brown E, Tarrant, C. Medical prescribing and antibiotic resistance: A game-theoretic analysis of a potentially catastrophic social dilemma. PLOS One 2019 April 19, 2019
  • Tarrant C, Colman AM, Chattoe-Brown E, Jenkins DR, Mehtar S, Perera N, Krockow EM. Optimising antibiotic prescribing: Collective approaches to managing a common-pool resource. Clinical Microbiology & Infection 2019 (in press) DOI:
  • Krockow EM, Tarrant C. The international dimensions of antimicrobial resistance: contextual factors shape distinct ethical challenges in South Africa, Sri Lanka and the United Kingdom. Bioethics 2019 (in press) DOI: 10.1111/bioe.12604
  • Chattoe-Brown E, Colman AM, Jenkins DR, Krockow EM, Mehtar S, Perera N, Tarrant C. So You Got Two Ologies? The Challenge of Empirically Modelling Medical Prescribing Behaviour and its Effect on Anti-Microbial Resistance as a Case Study. IN Verhagen, Harko; Borit, Melania; Bravo, Giangiacome; Wijermans, Nanda (2019) Advances in Social Simulation: Looking in the Mirror. Springer
  • Krockow EM, Colman AM, Chattoe-Brown E, Jenkins D, Perera N, Mehtar S, Tarrant C. Balancing the risks to individual and society: a systematic review and synthesis of qualitative research on antibiotic prescribing behavior in hospitals. Journal of Hospital Infection. 2019. 101 (4), 428-439

Articles and blogs


This project is funded by the Global Challenges Research Fund, and this grant is awarded by the Economic and Social Research Council (ESRC) on behalf of the Research Councils UK (RCUK).

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