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Antibiotic over-prescription is promoted by pediatricians' perception of parents' expectations. Research published in the open access journal BMC Pediatrics shows that pediatricians are more likely to inappropriately prescribe antibiotics for respiratory tract infections if they perceived parents were expecting a prescription.

Researchers from the Agenzia Sanitaria e Sociale Regionale Emilia-Romagna, in collaboration with the CeVEAS-AUSL Modena and the Regional ProBA Group in Italy used a two-step survey to first investigate family and hospital pediatricians' knowledge and attitude towards antibiotics, as well as that of parents', and then to determine the factors associated with pediatricians' actual practices of antibiotic prescription. They found that for parents, lack of knowledge was the most important factor potentially associated with over-prescription. For the pediatricians questioned, 56% thought that diagnostic uncertainty was the main cause of antibiotic over-prescription, and only 20% suggested that parental expectations of a prescription was to blame. However, in observed practices, parental expectation of a prescription, as perceived by the doctor, was the second highest factor significantly associated with actual prescription, with the most important factor being discharge from the child's ear.

"A wide gap between perceived and real determinants of antibiotic prescription exists", says lead researcher Maria Luisa Moro, "This can promote antibiotic overuse." Unnecessary prescription of antibiotics is dangerous as it increases the prevalence of antibiotic resistant bacteria. Of the European countries, Italy has particularly high rates of antibiotic prescription and resistance, therefore reducing inappropriate antibiotic use in this country is particularly important. She concludes, "All of the above results confirm the crucial role of cultural factors as well as social factors in determining the pattern of antimicrobial prescribing in a region."