Inappropriate antibiotic use (IAU) is a major cause of increased antibioresistance, a phenomenon responsible for over one million annual deaths worldwide and for additional expenses for healthcare systems. More than 75% of antibiotic prescriptions are made by general practitioners (GPs). Various interventions have already been developed and evaluated. This could provide useful insight to build and implement effective interventional programmes to reduce IAU.To assess the efficacity of interventions targeting GPs to reduce IAU in common acute infections in general practice, that were developed and tested in OECD countries.We conducted a systematic review of randomized controled trials (RCTs) of interventions aiming at reducing the number of antibiotic prescriptions and/or reducing the duration of antibiotherapy and/or improving the choice of molecules. We followed the PRISMA guidelines (protocole registration Prospero CRD42024603824).  Pubmed, the Cochrane Library and Scopus were searched up to February 2024.  The eligibility criteria were RCTs conducted among GPs practicing in OECD countries, evaluating interventions targeting GPs to modify their antibiotic prescriptions habits. Control was the absence of intervention or an intervention targeting another prescription behavior Two reviewers independently screened records on Rayyan to apply eligibility criteria and select studies for inclusion. Conflicts were solved through discussion between 2 or 3 researchers. Data was extracted in an Excel Spreadsheet. Cochrane Risk of Bias 2 tool was used for quality assessment.The search retrieved 1530 articles, of which 27 were included. The RCTs evaluated interventions that involved (i)clinical reminders (n=2), (ii)distribution of educational material (n=2), (iii)communication assistance or training (n=4), (iv)stimulation of reflexivity (n=4), (v)rapid biological testing (n=6) or (vi)multifacetted interventions (n=9). The risk of bias was low or raised some concerns for 16 studies. Multifacetted interventions and rapid biological testing seemed to be the most effective.Despite strong methodology, this work is not without limits, with a risk of selection and publication bias. A meta-analysis is planed after actualisation of the search (ongoing). We did not include pluriprofessional interventions. The efficacy of multifacetted interventions could be related to their action on multiple determinants, and on the reduction of uncertainty for rapid testing.Interventional programmes should favor multifacetted complex interventions.

Understanding of how discussions and perceptions amongst patients is changing over time with regards to sore throat management and antibiotic usage is critical to inform interventions that reduce inappropriate antibiotic use, which is particularly high for respiratory tract infections (RTI).To explore changes in antibiotic usage and perception for RTIs over time in multiple countries.The STAR study (2022: 12 countries; 2024: 16 countries) is an observational, questionnaire-based study in adults (18–64). Here we report on data from Germany, Spain, Italy, Poland, Romania, the UK, and the Netherlands. Participants had experienced and treated RTI symptoms in the past 6 months. The online questionnaire explored RTI experience, antibiotic use, attitudes, and behaviours toward antibiotics and AMR.Comparing total populations, the top three reasons for antibiotic usage were cold, flu, and throat infection (59% of all antibiotic usage in 2022 and 61% in 2024), significantly more frequent than all other reasons combined (p<0.0001). Overall, reported antibiotic use increased significantly from 2022 to 2024 (55.65% vs 58.74%; p<0.0001). Younger adults (25–34) consistently reported higher usage than the total sample (18–64 years) in both years. Agreement that antibiotics kill viruses (a false belief) rose from 55.98% (2022) to 58.45% (2024) p<0.0001, with higher agreement among younger adults.RTIs are widely recognised as an area of inappropriate antibiotic use, and these data show high and increasing usage across three predominantly viral RTIs. Misunderstandings persist about antibiotic effectiveness for self-limiting RTIs, despite public health efforts to curb misuse. Younger adults (25–34) continue to report higher usage and misperceptions, highlighting the need for targeted educational interventions for this demographic. A symptom relief-based approach to managing primarily viral RTIs can limit inappropriate antibiotic use and provide benefits antibiotics cannot.Antibiotic use for predominantly viral cold, flu, and throat infection is increasing, especially among younger adults, underscoring the need for enhanced targeted education and research in, and endorsement of, symptomatic alternatives. Misunderstandings and differing attitudes underpin current trends. GPs and pharmacists are ideally placed to change patient perceptions and expectations on managing RTIs and rationalising antibiotic use.

Antibiotic resistance is a major public health issue worldwide and is largely driven by inappropriate use. In XXX, more than 5500 deaths were attributed to infections caused by resistant bacteria in 2015, and up to 238000 deaths are projected by 2050 if no action is taken. Although general practitioners are key actors in antibiotic stewardship, antibiotic self-medication remains insufficiently studied despite its role in resistance development.To assess the prevalence of antibiotic self-medication over the last 12 months and identify its associated factors among adult outpatients in XXX.We conducted a descriptive cross-sectional study using a self-administered questionnaire. Inclusion criteria were being over 18 years of age and residing in or attending a healthcare facility in the department of XXX. Questionnaires were distributed in paper form and online. Data were collected over a 60-day period. Statistical analyses compared participants who reported antibiotic self-medication within the past 12 months with those who did not or were unsure.A total of 1405 respondents were included (91.5% women). The prevalence of antibiotic self-medication in the previous 12 months was 18.7%. Antibiotics used for self-medication mainly came from prior personal prescriptions (89.3%). The main symptoms leading to self-medication were respiratory (38.4%) and upper respiratory tract symptoms (38.02%). Patients who self-medicated were more likely to report a medical appointment delay of over one week than those who did not (37.26% vs. 27.34%, p=0.003) and to keep leftover antibiotics at home (88.97% vs. 63.66%, p<0.01). Patients over 65 were significantly underrepresented in the self-medication group (5.32% vs. 9.63%, p=0.03).These results highlight the need to strengthen prevention at each antibiotic prescription by reminding patients that antibiotics should not be reused without a medical assessment. Measures may include patient education, reinforced counseling by community pharmacists, visual educational materials in waiting rooms, and clear written instructions on prescriptions. Raising awareness of antibiotic self-medication could be an additional lever against antimicrobial resistance, although reducing antibiotic prescribing remains the main challenge, as nearly 50% of prescriptions are considered inappropriate.Antibiotic self-medication among outpatients remains common in XXX, and this study highlights several determinants on which targeted interventions could be implemented.

Antimicrobial resistance (AMR) remains a global health threat, and reducing unnecessary antibiotic use is essential. In 2017, the XXX Ministry of Health set the goal to halve inappropriate antibiotic prescribing. Traditional surveillance focused on prescription counts without linking to clinical indications, limiting insight into overprescribing and opportunities for improvement. The SABEL project was initiated to provide indication-linked quality indicators and practical tools for stewardship in general practice.Routine care data from GP information systems were analyzed to create 14 QIs, including overall prescribing rates, use of broad-spectrum antibiotics, and first-choice prescribing per indication. These indicators were piloted through pharmacotherapeutic peer group meetings (FTO), combined with tailored education on guideline adherence to make a definitive selection. This selection is used for data drive feedback in FTO sessions. Individual results of GPs are discussed (generated by QIs) and tailored education is given by GP experts to achieve better antibiotic prescribing.GPs rated the indicators as highly relevant (88%) and useful (91%). After FTO sessions, 72% expected changes in prescribing behavior. Trend analyses (2018–2023) show stable or improved adherence to first-choice prescribing, despite temporary declines during COVID-19. However, practice variation remains substantial, largely driven by prescriber behavior rather than patient characteristics.This project appears to have a positive effect on antibiotic prescribing in primary care. However, GP participation is voluntary, recruiting GPs is intensive and it's questionable whether the worst performers will volunteer for this FTO.The SABEL toolkit combines data-driven feedback with peer education to support rational antibiotic use in primary care. This approach strengthens stewardship efforts and can be adapted for other European contexts. Sustained implementation and monitoring are essential to maintain progress against AMR.

Antimicrobial resistance and antibiotics inappropriate use in general practice (GP) are a major issue. Shared decision-making (SDM), that can be enhanced by decision aids (DAs), seem efficient to reduce prescriptions. Their use remains inconsistent. Understanding the processes of patients and physicians SDM and the associated determinants could help improve their implementation.The objective was to explore the determinants of SDM between patients and GPs regarding antibiotic prescription in primary care.Systematic review and metasynthesis of qualitative studies that explored SDM about antibiotic prescription in GP. We included published studies focusing on GP consultations for acute infections, involving adult patients (or legal representatives for minors). We searched Pubmed, SCOPUS, PsycINFO, PsycArticle, CINAHL, Socindex, Psychology and Behavioral Sciences Collection. Two reviewers independently assessed the articles for eligibilty, based on titles and abstracts, then full text. Data were analysed following the framework synthesis method. The a priori codebook integrated the SDM, clinical reasoning processes and DAs frameworks.The search retrieved 437 references, of which 10 were included. SDM was usually limited or absent. Patients’ and physicians’ respective beliefs and representations were major determinants, with negative impact. A major difficulty was to reach a shared objective. This issue was not addressed by DAs, which mainly provided support to better structure the consultation and provide information. GPs seemed to use DAs mainly as tools to convince patients.Beyond the role of well-known determinants, like personal beliefs, past experiences,  our results provide important insight on the importance of establishing clear objectives to the consultation as the indispensable basis to really co-construct the final decision. DAs can help structure a more balanced discussion but remain used mainly as information material. There might be selection and interpretation biases, balanced by using a solid method. Analysis is strengthened by valid frameworks.To efficiently strengthen SDM, DAs should be oriented towards a global plan of care rather than just antibiotic prescription. They need to help patients and GPs to reach clear shared objectives that should include the need for explanations (notably symptoms and natural course of the illness), reassurance, alternatives, in addition to graphic representation of expected effect of antibiotics.