Between Patient Pressure and Professional Responsibility: Antibiotic Prescribing Practices in Primary Care

Background/Objectives: Antimicrobial resistance (AMR) represents one of the most pressing global public health challenges, with inappropriate antibiotic prescribing being a major contributor. In Hungary, general practitioners (GPs) account for over 70% of all antibiotic prescriptions, yet limited research has examined the complex relationship between patient expectations and physician prescribing behavior. This study explores general practitioners' antibiotic prescribing practices and their perceptions of patient expectations. Methods: A cross-sectional study was conducted among 181 GPs in Hungary from March 2024 to April 2025. The sample is representative of the northeastern region of Hungary. Participants completed anonymous paper-based questionnaires assessing their self-reported professional knowledge, perceived patient expectations, prescribing behavior, and antibiotic stewardship practices. Results: Most respondents recognized antimicrobial resistance as a significant public health issue (81.7%, n = 147); however, only 52.2% (n = 94) felt capable of effectively taking action against it. While 80.6% (n = 145) reported that patients expect antibiotic prescriptions and 71.1% (n = 128) experienced conflicts over prescribing refusals at least once within the previous six months, 87.2% (n = 157) stated they do not yield to patient pressure. Concerning patterns emerged: 56.1% (n = 101) reported completing patient-initiated antibiotic courses, 36.1% (n = 65) admitted to "just-in-case" prescribing at least once within the past six months, and 38.9% (n = 70) encountered self-medication despite regulations restricting antibiotics to prescription-only use. Only 17.8% (n = 32) regularly monitored their antibiotic prescribing indicators. Physicians with multiple specialty qualifications reported less frequent patient education and more conflicts (p = 0.010). Conclusions: General practitioners demonstrate resilience despite substantial patient pressure; however, self-medication and defensive prescribing practices reveal important gaps in antimicrobial stewardship. Targeted, multifaceted interventions addressing both prescriber behavior and systemic vulnerabilities are needed to strengthen stewardship efforts.