Behavioural Dimensions of Off-Label Antimicrobial Consumption and the Threat of Antimicrobial Resistance

Antimicrobial resistance (AMR) poses a major global public health threat, yet the behavioural drivers of antibiotic consumption remain underexamined. In this paper, we focus on off-label antibiotic consumption—use that falls outside formal medical guidance and is often enabled by self-medication and informal access. Rather than treating off-label antibiotic use as irrational misuse, we argue that these practices are patterned, predictable, and socially shaped. A behavioural lens is therefore essential for developing effective AMR policy interventions that go beyond regulatory and supply-side approaches to address the demand-side factors that sustain inappropriate antibiotic use. We make three contributions. First, we introduce a novel conceptual framework that categorizes types of off-label antibiotic consumption across the One Health domain. Second, drawing on insights from health economics, psychology, and behavioural science, we develop a complementary conceptual framework that identifies the behavioural drivers underlying these practices. Third, we supplement these frameworks with descriptive survey evidence from 486 households (972 individuals) in semi-urban Karnataka, India. Together, our conceptual and empirical insights highlight the importance of integrating behavioural science into AMR policy, improving the effectiveness of interventions while ensuring equity and access to essential antibiotics.