• Dongzhe Hong, Aaron S Kesselheim, Robert Morlock, Joshua P Metlay, John H Powers, and William B Feldman.
• Department of Medicine, Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA. dhong5@bwh.harvard.edu.
• J Gen Intern Med. 2024 Nov 25.

BackgroundThe development of new infectious disease therapies has become a public health priority given the suboptimal efficacy and adverse effects with current drugs for some patients. Understanding the factors associated with physician antibiotic prescribing preferences can help guide policymakers seeking to incentivize the development of interventions that improve patient outcomes for the treatment and prevention of infectious diseases.ObjectivesTo determine the factors associated with physician decision-making when prescribing antibiotics for community-acquired pneumonia (CAP), uncomplicated urinary tract infection (UTI), and cellulitis.DesignA cross-sectional online survey in April 2023.ParticipantsPhysicians enrolled in an online panel who reported having prescribed antibiotics within the past year.Main MeasuresRespondents were asked to select 1 to 15 characteristics that they deemed most important. From their selected characteristics, for each type of infection, they were then asked to rank up to five on a scale with 5 points given to the top-scoring characteristic and 1 point to the bottom-scoring. The primary outcome was the mean score for each characteristic across the three types of infections weighted by the number of respondents in the sample, with higher scores indicating higher importance.Key ResultsAmong the 130 physician participants, 106 (82%) completed the survey. Just under half (46%) were female; 89% of respondents were White, 3% Black, and 9% another race, while 15% reported Hispanic ethnicity. The highest-scored factors influencing antibiotic prescription preferences were the cure rate (treatment efficacy) (mean score: 2.87), severity of the infection (1.88), rare but major side effects (1.33), interactions with other drugs (1.33), previous experience and knowledge of the drug (1.19), and future risk of resistant infection to the patient (1.15). Out-of-pocket patient costs were prioritized lowest (mean score: 0.25).ConclusionsIn considering which antibiotic to prescribe, physicians prioritize clinical outcomes related to drug efficacy and safety over public health- or economics-focused factors.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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