{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T18:48:10Z","timestamp":1791485290434,"version":"4.3.4"},"reference-count":50,"publisher":"BMJ","issue":"12","funder":[{"DOI":"10.13039\/501100004047","name":"Karolinska Institutet","doi-asserted-by":"publisher","award":["KID-funding 3\u20131233\/2013"],"award-info":[{"award-number":["KID-funding 3\u20131233\/2013"]}],"id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,11,21]]},"published-print":{"date-parts":[[2019,12]]},"abstract":"\n Objective<\/jats:title>\n To identify factors that influence general practitioners\u2019 (GPs\u2019) oral antibiotic prescribing for acute respiratory tract complaints (aRTCs) in Malta.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Repeated, cross-sectional surveillance.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Maltese general practice; both public health centres and private GP clinics.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n 30 GPs registered on the Malta Medical Council\u2019s Specialist Register and 3 GP trainees registered data of 4831 patients of all ages suffering from any aRTC. Data were collected monthly between May 2015 and April 2016 during predetermined 1-week periods.<\/jats:p>\n <\/jats:sec>\n \n Outcome measures<\/jats:title>\n The outcome of interest was antibiotic prescription (yes\/no), defined as an oral antibiotic prescription issued for an aRTC during an in-person consultation, irrespective of the number of antibiotics given. The association between GP, practice and consultation-level factors, patient sociodemographic factors and patient health status factors, and antibiotic prescription was investigated.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The antibiotic prescription rate was 45.0%. Independent factors positively associated with antibiotic prescribing included female GP sex (OR 2.3, 95%\u2009CI 1.22 to 4.26), GP age with GPs \u226560 being the most likely (OR 34.7, 95%\u2009CI 14.14 to 84.98), patient age with patients \u226565 being the most likely (OR 2.3, 95%\u2009CI 1.71 to 3.18), number of signs and\/or symptoms with patients having \u22654 being the most likely (OR 9.6, 95%\u2009CI 5.78 to 15.99), fever (OR 2.6, 95%\u2009CI 2.08 to 3.26), productive cough (OR 1.3, 95%\u2009CI 1.03 to 1.61), otalgia (OR 1.3, 95%\u2009CI 1.01 to 1.76), tender cervical nodes (OR 2.2, 95%\u2009CI 1.57 to 3.05), regular clients (OR 1.3, 95%\u2009CI 1.05 to 1.66), antibiotic requests (OR 4.8, 95%\u2009CI 2.52 to 8.99) and smoking (OR 1.4, 95%\u2009CI 1.13 to 1.71). Conversely, patients with non-productive cough (OR 0.3, 95%\u2009CI 0.26 to 0.41), sore throat (OR 0.6, 95%\u2009CI 0.53 to 0.78), rhinorrhoea (OR 0.3, 95%\u2009CI 0.23 to 0.36) or dyspnoea (OR 0.6, 95%\u2009CI 0.41 to 0.83) were less likely to receive an antibiotic prescription.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Antibiotic prescribing for aRTCs was high and influenced by a number of factors. Potentially inappropriate prescribing in primary care can be addressed through multifaceted interventions addressing modifiable factors associated with prescription.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n NCT03218930<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-032704","type":"journal-article","created":{"date-parts":[[2019,12,19]],"date-time":"2019-12-19T06:25:21Z","timestamp":1576736721000},"page":"e032704","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Factors associated with antibiotic prescribing in patients with acute respiratory tract complaints in Malta: a 1-year repeated cross-sectional surveillance study"],"prefix":"10.1136","volume":"9","clinical-trial-number":[{"clinical-trial-number":"nct03218930","registry":"10.18810\/clinical-trials-gov","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1587-9591","authenticated-orcid":false,"given":"Erika A","family":"Saliba-Gustafsson","sequence":"first","affiliation":[{"name":"Department of Global Public Health, Health Systems and Policy: Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Dunberger Hampton","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Health Systems and Policy: Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Zarb","sequence":"additional","affiliation":[{"name":"Department of Infection Prevention and Control, Mater Dei Hospital, Msida, Malta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2210-5634","authenticated-orcid":false,"given":"Nicola","family":"Orsini","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Social Medicine, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A","family":"Borg","sequence":"additional","affiliation":[{"name":"Department of Infection Prevention and Control, Mater Dei Hospital, Msida, Malta"},{"name":"Faculty of Medicine and Surgery, University of Malta, Msida, Malta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"St\u00e5lsby Lundborg","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Health Systems and Policy: Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,12,18]]},"reference":[{"key":"2025121601570269000_9.12.e032704.1","unstructured":"World Health Organization . 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