PT  - JOURNAL ARTICLE
AU  - Domen, Julie
AU  - Aabenhus, Rune
AU  - Balan, Anca
AU  - Bongard, Emily
AU  - Böhmer, Femke
AU  - Bralić Lang, Valerija
AU  - Bruno, Pascale
AU  - Chlabicz, Slawomir
AU  - Colliers, Annelies
AU  - García-Sangenís, Ana
AU  - Ghazaryan, Hrachuhi
AU  - Kowalczyk, Anna
AU  - Jensen, Siri
AU  - Lionis, Christos
AU  - van der Linde, Tycho M
AU  - Malania, Lile
AU  - Pauer, Jozsef
AU  - Tomacinschii, Angela
AU  - Vellinga, Akke
AU  - Zastavnyy, Ihor
AU  - Goossens, Herman
AU  - Butler, Christopher C
AU  - van der Velden, Alike W
AU  - Coenen, Samuel
TI  - The effect of a GP’s perception of a patient request for antibiotics on antibiotic prescribing for respiratory tract infections: secondary analysis of a point-prevalence audit survey in 18 European countries
AID  - 10.3399/BJGPO.2024.0166
DP  - 2025 Jul 01
TA  - BJGP Open
PG  - BJGPO.2024.0166
VI  - 9
IP  - 2
4099  - http://bjgpopen.org/content/9/2/BJGPO.2024.0166.short
4100  - http://bjgpopen.org/content/9/2/BJGPO.2024.0166.full
SO  - BJGP Open2025 Jul 01; 9
AB  - Background Illness severity, comorbidity, fever, age, and symptom duration influence antibiotic prescribing for respiratory tract infections (RTI). Non-medical determinants, such as patient expectations, also impact prescribing.Aim To quantify the effect of a GP’s perception of a patient request for antibiotics on antibiotic prescribing for RTI and investigate effect modification by medical determinants and country.Design & setting Prospective audit of general practices in 18 European countries.Method Consultation data were registered of 4982 patients presenting with acute cough and/or sore throat. A mixed-effect logistic regression model analysed the effect of GPs’ perceptions of a patient request for antibiotics. Two-way interaction terms assessed effect modification. Relevant clinical findings were added to subgroups of lower RTI (LRTI), throat infection, and influenza-like-illness (ILI).Results A GP’s perception of a request for antibiotics meant they were four times more likely to prescribe antibiotics (odds ratio [OR] 4.4, 95% confidence interval [CI] = 3.4 to 5.5). This effect varied by country: lower in Spain (OR 0.06), Ukraine (OR 0.15), and Greece (OR 0.22) compared with the lowest prescribing country. The effect was higher for ILI (OR 13.86, 95% CI = 5.5 to 35) and throat infection (OR 5.1, 95% CI = 3.1 to 8.4) than for LRTI (OR 2.9, 95% CI = 1.9 to 4.3). For ILI and LRTI, GPs were more likely to prescribe antibiotics with abnormal lung auscultation and/or increased or purulent sputum and for throat infection, with tonsillar exudate and/or swollen tonsils.Conclusion GPs’ perceptions of an antibiotic request and specific clinical findings influence antibiotic prescribing. Incorporating exploration of patient expectations, point-of-care testing, and discussing watchful waiting into the decision-making process will benefit appropriate prescribing of antibiotics.