Abstract

BackgroundInappropriate antibiotic prescribing, particularly for respiratory tract infections (RTI) in ambulatory care, has become a worldwide public health threat due to resulting antibiotic resistance. In spite of various interventions and campaigns, wide variations in antibiotic use persist between European countries. Cultural determinants are often referred to as a potential cause, but are rarely defined. To our knowledge, so far no systematic literature review has focused on cultural determinants of antibiotic use. The aim of this study was to identify cultural determinants, on a country-specific level in ambulatory care in Europe, and to describe the influence of culture on antibiotic use, using a framework of cultural dimensions.MethodA computer-based systematic literature review was conducted by two research teams, in France and in Norway. Eligible publications included studies exploring antibiotic use in primary care in at least two European countries based on primary study results, featuring a description of cultural determinants, and published between 1997 and 2015. Quality assessment was conducted independently by two researchers, one in each team, using appropriate checklists according to study design. Each included paper was characterized according to method, countries involved, sampling and main results, and cultural determinants mentioned in each selected paper were extracted, described and categorized. Finally, the influence of Hofstede’s cultural dimensions associated with antibiotic consumption within a primary care setting was described.ResultsAmong 24 eligible papers, 11 were rejected according to exclusion criteria. Overall, 13 papers meeting the quality assessment criteria were included, of which 11 used quantitative methods and two qualitative or mixed methods. The study participants were patients (nine studies) and general practitioners (two studies). This literature review identified various cultural determinants either patient-related (illness perception/behaviour, health-seeking behaviour, previous experience, antibiotic awareness, drug perception, diagnosis labelling, work ethos, perception of practitioner) or practitioner-related (RTI management, initial training, antibiotic awareness, legal issues, practice context) or both (antibiotic awareness).Discussion and ConclusionCultural factors should be considered as exerting an ubiquitous influence on all the consecutive stages of the disease process and seem closely linked to education. Interactions between determinant categories, cultural dimensions and antibiotic use in primary care are multiple, complex and require further investigation within overlapping disciplines. The context of European projects seems particularly relevant.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2254-8) contains supplementary material, which is available to authorized users.

Highlights

  • Inappropriate antibiotic prescribing, for respiratory tract infections (RTI) in ambulatory care, has become a worldwide public health threat due to resulting antibiotic resistance

  • The highest rates of antibiotic prescriptions are observed in primary care for respiratory tract infections (RTI) [1]

  • Key words identified with the MeSH thesaurus included “culture” (MeSH definition described in the introduction section), “antibiotics”/“antibacterial agents”/“antimicrobial agents”

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Summary

Introduction

Inappropriate antibiotic prescribing, for respiratory tract infections (RTI) in ambulatory care, has become a worldwide public health threat due to resulting antibiotic resistance. Various determinants of antibiotic prescription have been suggested in the literature and cultural factors are often referred to as possible explanations of persistent differences in antibiotic consumption between countries. Harbarth and Monnet [6] published an overview of determinants that could explain differences in antibiotic use, which included cultural factors. They highlighted the importance of conducting further research, in particular to clarify the influence of cultural and socioeconomic determinants to guide interventions targeting appropriate antibiotic use

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