155 Routine data registries as a basis to analyse and improve the quality of antimicrobial prescription in Primary Care 6 with a Moroccan background is likely attributable to lower rates of smoking, which is a known risk factor for RTIs (40). GPs also tend to prescribe antimicrobial medication more easily if there is a risk of a complicated RTI, and smoking is also a prominent risk factor for complicated RTIs. These findings highlight important disparities between groups with different migration backgrounds. Comorbidity and female gender were also identified as determinants of antimicrobial overprescribing, associations previously reported in several studies (8-10, 19, 34). Comorbidity is considered a risk factor for severe course of an infection, so a GP may prescribe antimicrobials more readily to prevent more serious complications that might result in hospital admission (28). Female gender is associated with a higher incidence of infectious disease, leading to more frequent visits to the GP compared to men and consequently a higher number of antimicrobial prescriptions and a higher risk of overprescribing (41). In our study, an age of 5 years or older was also associated with antimicrobial overprescribing. Other studies have reported different age associations, but as these studies varied in design or population direct comparison is difficult. Two studies that covered all ages, including a retrospective cohort study in Canada of antimicrobial prescriptions for viral infections and a prospective observational study in The Netherlands with detailed registration of RTIs episodes, both found an association between antimicrobial overprescribing and an age between 18 and 65 years (8, 42). A retrospective cross-sectional study of bronchitis in Spain, including patients 15 years and older, also concluded that increasing age is associated with antimicrobial overprescribing (43). By contrast, a Dutch prospective observational study with detailed registration of 1,469 RTI episodes, which included patients of all ages, found no association with age (32). A possible explanation for our findings is that children below the age of 5 years more commonly experience infections such as otitis media acuta (28, 44), which is appropriately treated with antimicrobials. A further interesting finding of our study was the association of appropriate antimicrobial prescribing with a primary care practice size of less than 2,168 patients. Two Canadian studies found a comparable association for practice sizes less than 1,235 or 1,054 patients, respectively (8, 9). Conversely, a study from the UK reported no association between practice size and appropriate antimicrobial prescribing, although a medium size practice in that study was described as between 7,928 and 10,941 patients (10). Differences in practice location and definitions of practice size likely hamper proper comparison between studies. A possible explanation for antimicrobial overprescribing in larger primary care practices is that relatively less
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