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Metrics details. Antibiotic overprescription is a worldwide problem. Decisions regarding antibiotic prescription for respiratory tract infections RTIs are influenced by medical and non-medical factors. The observing residents completed a questionnaire including patient data, clinical symptoms, diagnosis, any prescribed antibiotic, and assessment of ten patient pressure factors. Of consultations of patients with RTIs, Antibiotic prescription was strongly associated with rales OR Direct request not to prescribe antibiotics decreased the likelihood of receiving antibiotics OR 0.

While clinical signs and symptoms principally impact prescribing decisions, patient factors also contribute. The most influential patient pressure factors were starting self-medication with antibiotics, and directly requesting antibiotic prescription or no antibiotic prescription. Interventions aiming to improve clinical sign and symptom interpretation and to help doctors resist direct patient pressure could be beneficial for reducing unnecessary antibiotic prescribing.

Peer Review reports. The majority of antibiotics prescriptions are issued in primary care for respiratory tract infections RTIs [ 1 , 2 ]. Most RTIs do not require antibiotic therapy as they are predominantly of viral aetiology and are self-limited in nature [ 3 , 4 ]. Multiple interventions aiming at decreasing unnecessary antibiotics prescriptions for common RTIs have been targeted to doctors [ 7 ].

There are reportedly multiple reasons for unjustified prescription of antibiotics [ 13 , 14 ], with pressure from patients and their families appearing to be an important factor [ 13 , 14 ]. Doctors may need to develop effective strategies to resist explicit or implicit requests to prescribe.