SynthesisBMJ open2023
Determinants of inappropriate antibiotic prescription in primary care in developed countries with general practitioners as gatekeepers: a systematic review and construction of a framework.
Synthesis in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
51 citing papers in PubMed, 3 syntheses or guidelines pooled it, 59 citations in OpenAlex.
- Mapping Evidence and Constructing an Analytic Framework: An Umbrella Review Summarizing Primary Care Family Physicians' Experiences With Clinical Integration.Annals of family medicine · 2025Pooled it
- Factors associated with inappropriateness of antibiotic prescriptions for acutely ill children presenting to ambulatory care in high-income countries: a systematic review and meta-analysis.The Journal of antimicrobial chemotherapy · 2024Pooled it
- Physicians', pharmacists', and nurses' education of patients about antibiotic use and antimicrobial resistance in primary care settings: a qualitative systematic literature review.Frontiers in antibiotics · 2024Pooled it
- Using a decision support tool to reduce inappropriate antibiotic use after a delayed prescription.Applied psychology. Health and well-being · 2026Trial
- General practitioners' type of remuneration and antibiotic prescriptions. An analysis of patient switches using nationwide registry data.Scandinavian journal of primary health care · 2026Article
- Is C-reactive protein the answer to antibiotics over-prescribing in primary care? A behavioural experiment in two European countries.JAC-antimicrobial resistance · 2026Article
- Packaged intervention targeting oral antimicrobials in Japanese tertiary care outpatient setting: a quasi-experimental study.JAC-antimicrobial resistance · 2026Article
- Diagnostic Performance of the MeMed BV Test to Distinguish Between Bacterial and Viral or Other Non-Bacterial Causes Amongst ED and Urgent Care Patients: A Systematic Review with Meta-Analysis.Diagnostics (Basel, Switzerland) · 2026Review
- Role of diagnostic testing in reducing unnecessary antibiotic use for upper respiratory tract infections in Chinese primary healthcare: a mixed-methods study.BMC primary care · 2026Article
- Antibiotic use appropriateness and its determinant factors among pediatric pneumonia patients in selected comprehensive specialized hospitals in Northwest Amhara, 2024: a prospective follow-up study.BMC infectious diseases · 2026Article
- When good knowledge falls short: identity and geography drive inappropriate antibiotic use in Malaysia.BMC public health · 2026Article
- Physicians' understanding of antibiotic prescribing in Korean long-term care hospitals: a multicenter cross-sectional study.Journal of health, population, and nutrition · 2026Article
- Review
- Comparison of antibiotic prescription indexes by patient and physician gender and age: a cross-sectional study based on administrative data.BMC primary care · 2026Article
- Article
- Barriers and enablers to using evidence-based antibiotic prescription guidelines in primary care: a qualitative systematic review and synthesis using the theoretical domains framework.Implementation science communications · 2026Review
- Knowledge, Attitudes and Dispensing Practices Regarding Antimicrobial Resistance and Stewardship:Sultan Qaboos University medical journal · 2026Article
- A feasibility study of the use of a patient leaflet for respiratory tract infection consultations in general practice in Ireland.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Prevalence and Predictors of Inappropriate Antibiotic Prescriptions Among Dentists in Muscat Governorate, Oman.Sultan Qaboos University medical journal · 2026Article
- Antibiotic Prescription Patterns in Poland in the Years 2019-2024 Based on Reimbursement Data from the National Healthcare Fund.Antibiotics (Basel, Switzerland) · 2025Article
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
objectivesThis study aimed to identify determinants of inappropriate antibiotic prescription in primary care in developed countries and to construct a framework with the determinants to help understand which actions can best be targeted to counteract development of antimicrobial resistance (AMR).
designA systematic review of peer-reviewed studies reporting determinants of inappropriate antibiotic prescription published through 9 September 2021 in PubMed, Embase, Web of Science and the Cochrane Library was performed.
settingAll studies focusing on primary care in developed countries where general practitioners (GPs) act as gatekeepers for referral to medical specialists and hospital care were included.
resultsSeventeen studies fulfilled the inclusion criteria and were used for the analysis which identified 45 determinants of inappropriate antibiotic prescription. Important determinants for inappropriate antibiotic prescription were comorbidity, primary care not considered to be responsible for development of AMR and GP perception of patient desire for antibiotics. A framework was constructed with the determinants and provides a broad overview of several domains. The framework can be used to identify several reasons for inappropriate antibiotic prescription in a specific primary care setting and from there, choose the most suitable intervention(s) and assist in implementing them for combatting AMR.
conclusionsThe type of infection, comorbidity and the GPs perception of a patient's desire for antibiotics are consistently identified as factors driving inappropriate antibiotic prescription in primary care. A framework with determinants of inappropriate antibiotic prescription may be useful after validation for effective implementation of interventions for decreasing these inappropriate prescriptions. PROSPERO REGISTRATION NUMBER: CRD42023396225.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.