Factors influencing antibiotic prescribing (EVA Study) among office-based physicians in Hesse, Germany, 2026 – evolution of influencing factors over time, frequency of antibiotic therapy, and suggestions for improvement (2008–2026)

Background and objective: Antibiotic-resistant pathogens (MDROs) are an urgent public health problem. Surveys on the factors influencing antibiotic prescribing among office-based physicians (EVA Study) were conducted in Germany in 2008 and in the state of Hesse in 2016. The EVA survey was repeated in Hesse in 2026 in order to analyze trends in the prescribing behavior of office-based physicians. Material and methods: The online survey included all office-based physicians in Hesse and contained questions on the factors influencing the respondent’s decision to prescribe antibiotic therapy, the relevance of antibiotic resistance, the respondent’s own expertise, and proposals for improving antibiotic therapy. The data were compared to the surveys in 2008 and 2016. Results: Of the 7,913 individuals contacted, 892 (11.3%) responded. 49.2% of respondents reported making daily decisions regarding antibiotic therapy (2016: 54.2%; 2008: 63.3%). The survey found a decrease in the non-medical reasons for prescribing. These included “to be on the safe side” 19.1% (2008: 27%), fear of legal consequences 11.2% (2008: 15.4%) and the patient’s desire to continue working 7.8% (2008: 19.1%). Perception of the relevance of antibiotic resistance rose from 66.8% (2008) to 82.8% (2026) and the awareness that one’s own prescribing behavior influences regional resistance increased from 51.1% to 62%. Conclusion: Office-based physicians reported that they prescribed antibiotics on a daily basis less frequently in 2026 than previously. The decline in psychological factors suggests an increased confidence in prescribing; however, organizational barriers are on the rise and should be specifically addressed.