Perspectives on antibiotic stewardship in the management of diarrhoea among children under five in Bangladesh: insights from clinicians and caregivers.

Antibiotic resistance is a critical global health threat, with over a million deaths linked to resistant infections every year. Inappropriate antibiotic use for childhood diarrhoeal illness is a significant contributor to antimicrobial resistance. This is particularly important in low-resource settings where antibiotics are often used without clear clinical indication. This study explored the knowledge and perspectives of antibiotic stewardship among clinicians and caregivers of paediatric patients in Bangladesh. In-depth interviews were conducted with 18 clinicians and 36 patient caregivers across three government hospitals. While few clinicians were familiar with the term 'antibiotic stewardship', most understood its core principles and supported judicious prescribing. Caregivers were generally unfamiliar with the concept of antimicrobial stewardship, though a few acknowledged the risks of antibiotic overuse. Clinicians described informal stewardship efforts but highlighted the absence of structured programmes. Key challenges to stewardship included community-level antibiotic dispensing by informal providers, staffing shortages, caregiver expectations for antibiotics, and pressure to satisfy families' perceived expectations. Despite barriers, clinicians expressed support for educational initiatives and system-level efforts to promote antibiotic stewardship. These findings underscore the need for integrated, facility- and community-based approaches like decision-making support tools for providers, institutional reviews of antibiotic use, and community education on the dangers of inappropriate antibiotic use. Strengthening antibiotic stewardship in low-resource settings like Bangladesh is essential to curb misuse and combat the growing threat of antibiotic resistance.