Prevalence of and Factors Associated with Antibiotic Prescription in Gynecological Practices in Germany

Background: Antibiotics are commonly used in gynecology, yet only limited outpatient prescribing data are available in Germany. The aim of this study is to estimate the prevalence of antibiotic prescriptions in gynecological practices and to identify patient and diagnostic factors. Methods: A retrospective cross-sectional analysis was conducted using anonymized electronic records from the IQVIA Disease Analyzer, including 344,187 women aged ≥16 years who had at least one gynecological visit in 2024. The primary outcome of interest was the prescription of an antibiotic. Consequently, the prevalence of antibiotic prescriptions was calculated overall and stratified by age group. Associations between potential factors and antibiotic prescriptions were assessed using multivariable logistic regression. Results: The overall prescription prevalence was 8.4% (29,007/344,187). Regarding the age distribution within the prescribed sample, the highest percentages were observed among women aged 31-40 years (25.6%) and 16-30 years (25.4%), while those aged 51-60 and >60 made up 12.9% and 19.1%, respectively. The most commonly prescribed agents were fosfomycin trometamol (35.9%), clindamycin (17.6%), and pivmecillinam (10.7%). Mastitis (OR 63.54, 95% CI 55.79-72.38), acute cystitis (OR 43.67, 95% CI 41.63-45.80), and unspecified urinary tract infection (OR 31.58, 95% CI 20.11-33.12) were strongly positively associated with AB prescription. Positive associations were also observed for acute vaginitis (OR 3.44, 95% CI 3.30-3.58), chlamydial infection (OR 6.27, 95% CI 5.77-6.81), and pregnancy (OR 1.95, 95% CI 1.85-2.05). Negative associations were observed for dysmenorrhea (OR 0.52, 95% CI 0.48-0.56), irregular menstruation (OR 0.65, 95% CI 0.60-0.71), menopausal disorders (OR 0.51, 95% CI 0.48-0.53), and ovarian cysts (OR 0.78, 95% CI 0.72-0.84). Conclusions: Antibiotic use in gynecology is low and strongly diagnosis-driven, primarily for urogenital infections. Signals of inappropriate prescribing in patients with candidiasis suggest a need for improved diagnostic accuracy and guideline adherence.