ArticleEpidemiology and infection2019
Determinants of antibiotic prescribing for upper respiratory tract infections in an emergency department with good primary care access: a qualitative analysis.
Article in Epidemiology and infection, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.
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Who cites it
21 citing papers in PubMed, 2 syntheses or guidelines pooled it, 36 citations in OpenAlex.
- Factors influencing physicians' antimicrobial prescribing decisions: A systematic review of qualitative studies.British journal of clinical pharmacology · 2025Pooled it
- Factors contributing to the variation in antibiotic prescribing among primary health care physicians: a systematic review.BMC primary care · 2024Pooled it
- Effectiveness of a clinical decision support algorithm (CDSA) on reducing unnecessary antibiotic prescriptions for upper respiratory tract infections among ambulatory HIV-infected adults in Mozambique: a cluster randomized controlled trial.BMC infectious diseases · 2026Trial
- Clinicians' perspectives on a primary healthcare intervention to reduce antibiotic prescription for acute lower respiratory tract infections in Barcelona (Spain): a qualitative study.Primary health care research & development · 2025Trial
- Evidence-to-Recommendation Framework for 2026 ACE Clinical Guideline on upper respiratory tract infections - rational antimicrobial use.Singapore medical journal · 2026Article
- Barriers and facilitators to implementing antimicrobial stewardship (AMS) in a Chinese tertiary hospital: a qualitative study based on the Consolidated Framework for Implementation Research (CFIR).BMC infectious diseases · 2026Article
- Factors influencing antibiotic prescription for respiratory tract infections among prescribers in Jinja City, Uganda: a qualitative study.BMC pulmonary medicine · 2026Article
- Using learner verification and transcreation to develop multicultural patient education materials for acute respiratory tract infections to decrease inappropriate antibiotic prescribing.PEC innovation · 2025Article
- Physician Feedback Reduces Antibiotic Prescribing for Uncomplicated Upper Respiratory Tract Infection in the Emergency Department.Antibiotics (Basel, Switzerland) · 2025Article
- Article
- Factors associated with blood culture sampling for adult acute care hospital patients with suspected severe infection: a scoping review using a socioecological framework.JAC-antimicrobial resistance · 2025Review
- Are physicians ready for precision antibiotic prescribing? A qualitative analysis of the acceptance of artificial intelligence-enabled clinical decision support systems in India and Singapore.Journal of global antimicrobial resistance · 2023Article
- What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review.BMJ open · 2023Article
- Positive Point-of-Care Influenza Test Significantly Decreases the Probability of Antibiotic Treatment during Respiratory Tract Infections in Primary Care.Diagnostics (Basel, Switzerland) · 2023Article
- A scoping review and behavioural analysis of factors underlying overuse of antimicrobials.JAC-antimicrobial resistance · 2023Article
- A multi-institutional exploration of emergency medicine physicians' attitudes and behaviours on antibiotic use during the COVID-19 pandemic: a mixed-methods study.Antimicrobial resistance and infection control · 2023Article
- Provider views on rapid diagnostic tests and antibiotic prescribing for respiratory tract infections: A mixed methods study.PloS one · 2021Article
- Risk prediction models to guide antibiotic prescribing: a study on adult patients with uncomplicated upper respiratory tract infections in an emergency department.Antimicrobial resistance and infection control · 2020Article
- Conceptualizations of clinical decision-making: a scoping review in geriatric emergency medicine.BMC emergency medicine · 2020Article
- Economic and Behavioral Influencers of Vaccination and Antimicrobial Use.Frontiers in public health · 2020Review
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Upper respiratory tract infections (URTIs) account for substantial attendances at emergency departments (EDs). There is a need to elucidate determinants of antibiotic prescribing in time-strapped EDs - popular choices for primary care despite highly accessible primary care clinics. Semi-structured in-depth interviews were conducted with purposively sampled physicians (n = 9) in an adult ED in Singapore. All interviews were analysed using thematic analysis and further interpreted using the Social Ecological Model to explain prescribing determinants. Themes included: (1) reliance on clinical knowledge and judgement, (2) patient-related factors, (3) patient-physician relationship factors, (4) perceived practice norms, (5) policies and treatment guidelines and (6) patient education and awareness. The physicians relied strongly on their clinical knowledge and judgement in managing URTI cases and seldom interfered with their peers' clinical decisions. Despite departmental norms of not prescribing antibiotics for URTIs, physicians would prescribe antibiotics when faced with uncertainty in patients' diagnoses, treating immunocompromised or older patients with comorbidities, and for patients demanding antibiotics, especially under time constraints. Participants had a preference for antibiotic prescribing guidelines based on local epidemiology, but viewed hospital policies on prescribing as a hindrance to clinical judgement. Participants highlighted the need for more public education and awareness on the appropriate use of antibiotics and management of URTIs. Organisational practice norms strongly influenced antibiotic prescribing decisions by physicians, who can be swayed by time pressures and patient demands. Clinical decision support tools, hospital guidelines and patient education targeting at individual, interpersonal and community levels could reduce unnecessary antibiotic use.
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