Appropriateness of Antibiotic Prescribing and Its Influencing Factors in Common Clinical Scenarios: A Vignette-Based Cross-Sectional Study From Karaikal, India

Background: Antimicrobial resistance (AMR) is a major global health threat driven by inappropriate antibiotic use. There is a lack of region-specific prescribing data from India. The primary objective of this study was to assess the appropriateness of antibiotic prescribing using standardized clinical vignettes. The secondary objectives were to evaluate factors influencing prescribing decisions and practitioners’ attitudes toward antimicrobial stewardship among medical practitioners in Karaikal, Puducherry, India. Methods: A cross-sectional study was conducted among 192 practitioners using eight validated clinical vignettes (1,536 prescribing decisions). The appropriateness of prescribing was assessed using national and international guidelines. The influencing factors and stewardship attitudes were evaluated using a five-point Likert scale. Statistical analyses included chi-square tests for categorical variables and Pearson correlation and multivariable linear regression for the total vignette score. Results: The overall prescribing appropriateness across the eight clinical vignettes was 57.2% (879 of 1,536). Overprescribing was most frequent for physiological leukorrhea, herpes zoster, asthma exacerbation, and upper respiratory tract infection (URTI). Higher appropriateness was observed among superspecialists, government/dual-sector doctors, and those with greater than 10 years of experience (p < 0.001). Experience greater than 10 years has independently predicted appropriateness. Strong support for antibiotic stewardship was also observed. Conclusion: Prescribing appropriateness improved with seniority, pointing out the need for targeted Continuing Medical Education (CME), guideline dissemination, and stewardship interventions to address AMR.