Worldwide antibiotic prescription practices in primary care and associated factors: A systematic review and meta-analysis.

Background: Antibiotic prescription is a major driver of antimicrobial resistance. However, evidence on antibiotic prescription practices is inadequate globally. This study aimed to assess antibiotic prescription practices and identify its associated factors in primary care worldwide.

Methods: PubMed, Embase, Web of science, and Global Index Medicus by WHO were searched from studies published between January 2000 and September 2023. Quantitative studies that investigated the antibiotic prescriptions practices were included in this study. Each study was assessed by at least 2 independent reviewers. Risk of bias was assessed using a modified Hoy tool. Quantitative studies were merged using Meta-analysis with random effects modeling. This study was registered with PROSPERO, CRD42022354143.

Results: A total of 174 studies were included. The pooled prevalence of antibiotic prescribing was 42.1% (95%CI [39.2%, 45.1%]). Subgroup analysis indicated that antibiotic prescribing in primary care have not changed significantly over the past 20years. The prevalence of inappropriate antibiotics prescriptions was 57.6% (95%CI [43.4%, 71.2%]). Patients with higher education levels were less likely to receive antibiotic prescriptions.

Conclusions: We observed high prevalence of antibiotic prescribing in primary care, especially in low- and middle-income countries. The prevalence of antibiotic prescription has not declined significantly over the past 20years. Therefore, it is necessary to review current antimicrobial stewardship strategies.