Determinants of prescribing behaviour of antibacterial drugs in Europe and use of appropriate nomenclature in the literature.

Antibacterial drugs are used in the treatment of bacterial infections. Increasing bacterial resistance rates are threatening their efficacy and place a huge burden on public health. There is a strong link between consumption and irrational prescribing behaviour versus the development of bacterial resistance. This review summarises important aspects of European prescribing behaviour for antibacterial drugs in primary care. Attributes of rational and irrational prescribing behaviour are explained. The most important determinants are investigated and discussed. An update on the use of appropriate nomenclature is also provided. Based on the findings, proposals for action are presented. Unlike other studies that focus on single determinants or prescribing behaviour on an individual level, this review considers prescribing behaviour at a systemic level. A PubMed search was conducted for search terms of prescribing behaviour. Inclusion criteria were literature published in the last five years (starting from 2020), antibacterial drugs, prescribing behaviour and related factors, Europe or European countries, and primary care. Studies solely referring to the hospital sector were excluded. This is followed by an update to the nomenclature investigation, referring to a previous analysis by Seifert and Schirmer (Naunyn-Schmiedebergs Arch Pharmacol 394:2153-2166 (2021)). Prescribing behaviour is shaped by multiple interrelated systemic and individual-level factors. Systemic factors relate to the structure of the healthcare system, whereas individual determinants refer to the single treatment decisions. In Europe, there is a strong North-South shift, with more rational prescribing in the North and problematic behaviour in the South. No significant improvements in decreasing use or appropriate drug choice have been observed in recent years, and the impact of the pandemic on prescribing practices is negative. The use of appropriate nomenclature in the literature did not improve, with a dominance of problematic terms. Policy measures are considered the most effective way of changing prescribing behaviour. Systemic changes are required before individual prescribing behaviour can improve. Conducted interventions had a positive effect in most cases but varied in their effect. Initial actions include restricting the use of antibacterial drugs to specific indications, making financial changes to encourage the use of first-line drugs, and improving infrastructure to enable targeted treatment through diagnostics. However, regulatory restrictions must be accompanied by guidance and stewardship programmes to improve adherence. In general, reforming the nomenclature in the literature is necessary to improve communication and prevent misunderstandings. Rational prescribing behaviour is a requirement for achieving a decrease in bacterial resistance.