Contexts and concepts influencing general practitioners’ and patients’ decision-making on antibiotic prescriptions for upper respiratory tract infections in the Northern Dutch-German cross-border region – a qualitative study

Redundant antibiotic prescribing in primary care is a key driver of antimicrobial resistance. In the northern Dutch-German border region (Ems-Dollart region), antibiotic prescription rates increase as one approaches the border, and the reasons for this trend still need to be fully understood. The first step to address inappropriate antibiotic prescribing is to understand the aspects influencing the decision-making of those involved, especially for common conditions like upper respiratory tract infections (URTIs) that are often associated with redundant antibiotic use. Therefore, we examined and compared the concepts and contexts influencing the decision-making of Dutch and German general practitioners (GPs) and patients in the Ems-Dollart region concerning antibiotic prescription for URTIs. From December 2023 to mid-April 2024, GPs (n = 20) and patients (n = 21) were interviewed. The interviews were recorded, transcribed, translated into English, and coded using MAXQDA 24.2.0 software. Two deductive and inductive coding cycles using primary- and sub-codes were applied. The coded data was analyzed using thematic discourse analysis methodology. While there were reported differences in guideline adherence, this study found that German and Dutch GPs employ quite similar approaches when diagnosing and treating URTIs. Antibiotic prescription was based on consistent aspects, including diagnostic results (such as elevated C-reactive protein levels), the severity of symptoms (including fever and prolonged duration), time constraints, and perceived patient pressure. Additionally, patient age (young children and older adults) and the presence of comorbidities were key considerations in antibiotic prescription for URTIs. Moreover, there are prevalent misconceptions among patients regarding the etiology of URTIs and the appropriate use of antibiotics. Some patients believe that bacteria primarily cause the common flu or think antibiotics are necessary to treat viral infections. This study explores GPs’ and patients’ perspectives on URTI treatment, including their management preferences and the utilization of home remedies and over-the-counter medications. In addition, it highlights the wide-ranging non-medical aspects influencing GPs’ decisions, underscoring their critical role in antimicrobial resistance stewardship initiatives. Furthermore, the study identifies patient misconceptions regarding URTIs, which may lead to inappropriate antibiotic requests. Addressing these aspects is essential for optimizing URTI management and promoting prudent antibiotic prescribing.