Primary Non-Adherence to First Antibiotic Prescriptions in Adults and Children with Acute Respiratory Tract Infections and Otitis Media in Germany: A Retrospective Cohort Study

Background/Objectives: Primary non-adherence (PNA), the failure to dispense a prescribed medication, has rarely been studied for antibiotics. This study aimed to estimate PNA to first antibiotic prescriptions in patients with documented acute respiratory tract infections and otitis media in Germany and to identify associated factors. Methods: First antibiotic prescriptions issued in 2022–2025 in general and pediatric practices (IQVIA Disease Analyzer database) were combined with pharmacy dispensing records (IQVIA Longitudinal Prescription database). PNA was defined as no dispensing of the prescribed substance within three days. Associated factors were assessed using multivariable logistic regression, separately for adults and children/adolescents. Results: Among 160,656 adults and 65,223 children and adolescents, PNA occurred in 12.9% and 13.7%, respectively; at least 80% of prescriptions were dispensed on the day of prescription. In adults, age 66–80 years (odds ratio [OR] 0.74; 95% confidence interval [CI] 0.70–0.78), tonsillitis (OR 0.74; 0.71–0.78), otitis media (OR 0.76; 0.70–0.82), pneumonia (OR 0.78; 0.73–0.84), and macrolides (OR 0.91; 0.88–0.94) were associated with lower odds of PNA, and hypertension (OR 1.09; 1.05–1.13), depression (OR 1.14; 1.10–1.19), and diabetes (OR 1.12; 1.07–1.17) with higher odds. In children and adolescents, age 6–12 years (OR 1.23; 1.17–1.30) and prescription in 2023 (OR 1.36; 1.29–1.44) were associated with higher odds. Adjusted absolute differences were mostly below four percentage points. Conclusions: Approximately one in eight first antibiotic prescriptions in patients with documented acute respiratory tract infections or otitis media was not dispensed within three days. Whether this reflects appropriate non-use or potentially harmful non-adherence remains unclear.