Determinants of Antibiotic Prescribing for Acute Respiratory Infections in Primary Care: A Retrospective Cross-Sectional Study at the Eduardo Mondlane University Health Center, Maputo, Mozambique
This retrospective cross-sectional study at Eduardo Mondlane University Health Center in Maputo reveals that antibiotic prescribing for acute respiratory infections is driven primarily by clinical presentation rather than formal diagnosis or demographics, with a high overall prescribing rate of 69.4% that underscores the urgent need for context-specific antimicrobial stewardship interventions.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
Every day, millions of people walk into clinics around the world with a cough, a fever, or a sore throat. These are acute respiratory infections, a broad term for illnesses that strike the nose, throat, and lungs. While many of these infections are caused by viruses and will clear up on their own, doctors often face a difficult choice: should they prescribe an antibiotic? Antibiotics are powerful medicines that kill bacteria, but they do nothing for viruses. When they are used unnecessarily, they contribute to a growing global crisis where bacteria learn to survive these drugs, making future infections harder to treat. In places like Mozambique, where access to advanced medical testing can be limited, doctors must rely heavily on what they see and hear during a consultation to make this decision. Understanding exactly what tips the scale toward prescribing a pill is crucial for protecting the effectiveness of these medicines for everyone.
Researchers at the Eduardo Mondlane University Health Center in Maputo, Mozambique, set out to understand the specific reasons why doctors prescribe antibiotics for these respiratory infections. They looked back at the medical records of 196 patients who visited the clinic between April and August 2024. The team wanted to know if the decision to prescribe a drug was driven by the patient's age, their gender, the specific name of the illness, or simply the symptoms the patient was showing at that moment. They also examined which types of antibiotics were being used most often. The study found that the decision to prescribe was not random, nor was it based on who the patient was. Instead, it was driven almost entirely by the clinical picture presented during the visit.
The data revealed a striking pattern. Nearly 70 percent of the patients in the study received an antibiotic prescription, a rate significantly higher than what global health organizations recommend for these types of illnesses. When the researchers dug into the details, they discovered that the specific diagnosis written in the chart—whether it was pneumonia, bronchitis, or a viral infection—did not predict whether a patient would get a prescription. Similarly, the patient's age, their gender, and even whether the doctor was local or from another country made no statistical difference. The only factors that truly mattered were the symptoms the patient described and the type of medical professional they saw. Compared to patients whose main complaint was a cough, those presenting with fever, nasal congestion, or a runny nose were actually less likely to receive an antibiotic prescription. Additionally, patients seen by general nurses were significantly less likely to get antibiotics than those seen by general practitioners.
The types of medicines prescribed also told an important story. The most common drug given was amoxicillin, followed closely by azithromycin. Together, these two drugs accounted for the vast majority of all prescriptions. However, nearly half of the antibiotics prescribed belonged to a category that health experts watch closely because they are more likely to encourage drug resistance. The researchers noted that doctors often prescribed combinations of two different antibiotics, a practice that is generally reserved for more severe cases. This suggests that the pressure to treat the visible symptoms of illness often overrides the more cautious approach of waiting to see if the body can fight the infection on its own.
The study concludes that in this specific clinic, the path to an antibiotic prescription is paved by the immediate symptoms a patient shows, rather than by a confirmed diagnosis or demographic factors. The doctors are reacting to the fever and the cough in front of them, not necessarily to the underlying cause of the illness. This finding highlights a critical opportunity for improvement. If the decision to prescribe is based on symptoms that often appear in viral infections, then training doctors to recognize when these symptoms do not require antibiotics could drastically reduce unnecessary use. The researchers suggest that tailored programs to guide these clinical decisions could help slow the rise of drug-resistant bacteria, ensuring that these life-saving medicines remain effective for the community.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.