Antibiotic prescribing for acute respiratory tract infections in primary care: a systematic review and meta-ethnography

Objectives: Numerous interventions have been developed to promote prudent antibiotic use for acute respiratory tract infections (ARTIs). While reviews have assessed which interventions may be most effective, none has examined why some interventions may be more effective than others. Knowing what general practitioners (GPs) feel is acceptable and feasible to implement may help to answer this question. Methods: A systematic review was undertaken of 12 studies of GPs' views and experiences of antibiotic prescribing and/or interventions promoting the prudent use of antibiotics. A meta-ethnographic approach was followed to synthesize the findings. Results: Thirteen themes were identified from the synthesis. The first discussed GPs' satisfaction with their prescribing decisions. Seven themes highlighted factors that influence GPs' prescribing decisions; these included perceptions of external pressure to reduce prescribing, uncertainty about ARTI management and previous experience of ARTI management. Five themes highlighted the benefits of interventions that had helped GPs to prescribe more prudently in practice. The last two sets of themes were linked to indicate that interventions may only be beneficial for GPs when they address one or more of the factors that influence their prescribing decisions. Conclusions: The findings suggest that interventions should incorporate five aspects to promote prudent use whilst remaining attractive to GPs and feasible in practice. In order to maximize acceptability, interventions should: allow GPs to reflect on their own prescribing; help decrease uncertainty about appropriate ARTI management; educate GPs about appropriate prescribing; facilitate more patient-centred care; and be beneficial to implement in practice.