Search Results (141)

Several decades of intensive research into antidiabetic therapeutics have yielded an expansive, mechanism-driven pharmacopeia. Yet, the clinical endpoint for these diverse agents remains singular and superficial: the reduction in glycated hemoglobin (HbA1c). By focusing primarily on downstream glucose lowering, current therapeutic paradigms treat the symptom rather than the etiology. This approach persists despite definitive consensus that the foundational pathology of type 2 diabetes is much more complex which paves the way to insulin resistance, not merely the spillover of glucose into the bloodstream. This systemic misalignment raises a critical question for the scientific community: are we collectively “agreeing to disagree” on a biological fact or a clinical myth? The Myth is that ‘Persistent hyperglycemia’ is the disease itself, but the fact is: hyperglycemia is a late-stage biomarker of systemic insulin resistance. By managing the biomarker rather than the root cause, clinical medicine has normalized an incomplete treatment model. This review aims to deliberately provoke a shift in rational thinking. We challenge the comfortable status quo of accepting hyperglycemia as the primary definition of diabetes. True therapeutic innovation requires moving past this consensus of convenience. We must reorient basic and clinical science toward reversing the cellular mechanisms of insulin resistance itself, rather than settling for the cosmetic management of blood glucose levels. Rather than merely recounting established therapeutic mechanisms, this review systematically bridges classical antidiabetic pharmacology with the specific pharmacogenomic determinants likely driving hyperglycemia and phenotypic insulin resistance. Mechanisms of action and pharmacogenomic perspectives of α-glucosidase inhibitors, Sulfonylureas, SGLT2 inhibitors, GLP-1 agonists, Meglitinides, Insulins, Metformin, Thiazolidinediones, and DPP4 inhibitors are discussed in this review. In conclusion, mapping the pharmacogenetic landscape of antidiabetic therapies reveals how distinct genetic variations likely dictate drug metabolism and insulin receptor kinetics. Decoding these patient-specific mechanisms is essential to reverse tissue-specific insulin resistance and transition from empirical prescribing to precise, genotype-directed diabetes management. Full article

Background/Objectives: The use of antidepressants and anxiolytics has increased worldwide, raising concerns about treatment patterns, medication safety, and rational use. This study aimed to characterize the frequency, utilization patterns, and safety-related aspects of antidepressant and anxiolytic use among healthcare students and university staff at a Brazilian public university. Methods: A cross-sectional study was conducted between September 2024 and June 2025 using an online questionnaire administered to students and staff at the University of São Paulo, Brazil. Descriptive statistics and multivariable logistic regression were applied to characterize medication utilization patterns and evaluate factors associated with antidepressant and/or anxiolytic use. Results: Among the 300 participants, 167 (55.7%) reported antidepressant and/or anxiolytic use during the previous six months. Most users reported treatment for more than one year (59.9%), anxiety as the primary indication (68.3%), and prescription by a healthcare professional (93.4%). A total of 203 medications were reported, with selective serotonin reuptake inhibitors being the most common pharmacological class (42.4%). Among users, 99 (59.3%) reported at least one self-reported adverse effect, most commonly excessive drowsiness, reduced libido/sexual dysfunction, dry mouth, headache, and nausea. No statistically significant independent associations were identified between antidepressant and/or anxiolytic use and the evaluated sociodemographic characteristics. Conclusions: Antidepressant and anxiolytic use was frequently reported and was characterized by predominantly long-term, professionally prescribed treatment and frequent self-reported adverse effects. These findings may inform institutional strategies to improve access to mental healthcare while promoting the rational and safe use of psychotropic medications within university settings. Full article

Wolfiporia extensa (Peck) Ginns (WE) is a fungus widely used in Traditional Chinese Medicine. Its four medicinal parts, Poria (WP), Rubra Poria (RP), Poriae Cutis (PC), and Poria Cum Pini Radix (PPR), are prescribed for distinct therapeutic purposes; however, their quality standards and pharmacological differences remain unclear. This study established reliable quality markers and compared the neuroprotective activities of four medicinal parts of WE. Seven triterpenoids were quantified using validated high-performance liquid chromatography (HPLC) assays, while monosaccharide profiles were analyzed using 1-phenyl-3-methyl-5-pyrazolone-HPLC. The International Commission on Illumination L*a*b* colorimetry and chemometric models were used for authentication. The neuroprotective effects of aqueous extracts were assessed in SH-SY5Y, BV-2, and HOG cell models. Network pharmacology was used to predict compound–target pathway relationships. The content of poricoic acid A (PAA) was the highest in PC; the content of pachymic acid (PA) was the highest in RP; whereas dehydrotumulosic acid (DTUA) was enriched in WP. WP demonstrated the highest mannose and galactose content. The water extract of WP reduced H₂O₂-induced cytotoxicity in SH-SY5Y cells, whereas the PC extract alleviated L-α-lysophosphatidylcholine-induced injury in human oligodendroglioma cells. Network analysis identified PA, PAA, and poricoic acid B (PAB) as candidate bioactive compounds involved in neuroprotective effects. The PA/PAB ratios of ≥10, 1–9, and ≤1 were used to identify WP, RP, and PC, respectively. L* values of >80, 55–79, and <55 effectively discriminated WP, RP, and PC, respectively. This integrative study identified chemical and functional quality markers and demonstrated distinct neuroprotective profiles in different parts of WE, supporting their standardized and rational application in traditional medicine and nutraceuticals. Full article

Background: Adverse drug reactions (ADRs) represent a major and often underestimated source of morbidity, hospitalization, and functional decline in older adults. The convergence of age-related pharmacokinetic and pharmacodynamic changes, multimorbidity, polypharmacy, and frailty creates a clinical environment in which ADR risk is not static but evolves along progressive trajectories—from mild, early manifestations toward severe, potentially irreversible outcomes. Understanding these trajectories is essential for rational geriatric prescribing. Methods: This narrative review synthesizes evidence from epidemiological studies, systematic reviews, Cochrane analyses, and clinical trials published between 2000 and 2025, focusing on adults aged 65 years and older with two or more chronic conditions. Sources were identified through a structured, non-systematic literature search of PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus using the terms ‘adverse drug reactions’, ‘polypharmacy’, ‘multimorbidity’, ‘frailty’, ‘deprescribing’, and ‘pharmacokinetics’ in older adults, alone and in combination. Evidence quality was assessed narratively, distinguishing trial evidence from observational and expert consensus data. Results: ADRs in older adults are best classified using complementary frameworks—the augmented Type A to withdrawal Type E and failure-of-therapy Type F taxonomy (Types A–F), the Dose-Time-Susceptibility (DoTS) classification, and the EIDOS mechanistic scheme—which together capture the heterogeneity of drug-related harm in this population. Age-related pharmacokinetic changes (altered absorption, increased volume of distribution of lipophilic drugs, reduced hepatic and renal clearance) and pharmacodynamic shifts (heightened receptor sensitivity, baroreflex impairment, increased blood–brain barrier permeability) interact with polypharmacy and frailty to amplify ADR trajectories from mild to severe. Anticholinergic burden, prescribing cascades, and inappropriate polypharmacy function as structural accelerators of these trajectories. Medication review and deprescribing improve prescribing quality but evidence for hard outcome benefits remains of low to very low certainty. Emerging AI-enabled digital tools show promising accuracy for identifying frailty and pharmacological vulnerability, but this performance relates to frailty classification and has not yet been shown to prevent ADR trajectories; they require validation for routine clinical use. Conclusions: Recognizing ADRs in older adults as dynamic trajectories rather than isolated events repositions prescribing review and deprescribing from optional to essential clinical acts. An integrated approach combining pharmacological vigilance, comprehensive geriatric assessment, structured deprescribing, and emerging digital decision-support tools offers the most realistic pathway to reduce the trajectory-related burden of drug-related harm in complex older patients. Full article

Background/Objectives: Urinary tract infections (UTIs) are among the most common bacterial infections in children and represent a leading indication for antibiotic prescribing across inpatient, emergency department, and outpatient settings. Despite the availability of multiple international guidelines, prescribing practices for pediatric UTI frequently deviate from evidence-based recommendations in antibiotic selection, route of administration, and duration of therapy. These suboptimal practices contribute to the emergence of resistant uropathogens, including extended-spectrum β-lactamase-producing organisms, and highlight the need for a comprehensive stewardship approach specific to this population. Methods: A literature search was performed using PubMed and MEDLINE from January 2000 to May 2026 using the following search terms: urinary tract infection, children, pediatrics, antibiotic stewardship, antimicrobial resistance, diagnosis, treatment, duration, prophylaxis, and intravenous-to-oral transition. Thirteen active international guidelines published between 2011 and 2025 were identified and evaluated with specific emphasis on the integration of antibiotic stewardship principles. Clinical trials, systematic reviews, meta-analyses, and quality improvement studies addressing stewardship-relevant outcomes in pediatric UTI were included. Case reports were excluded. Results: Comparative analysis of 13 international UTI treatment guidelines demonstrated substantial variation in diagnostic criteria, treatment duration, and prophylaxis recommendations, with most guidelines predating the SCOUT, STOP, and INDI-UTI randomized controlled trials. Diagnostic stewardship interventions targeting urine collection methods, urinalysis-guided treatment decisions, and avoidance of antibiotic treatment for asymptomatic bacteriuria represented high-impact opportunities to reduce unnecessary antibiotic exposure. Oral antibiotic therapy was as effective as intravenous therapy for most children with pyelonephritis, and early intravenous-to-oral transition was supported by consistent randomized controlled trial evidence. A 5-day oral course may be reasonable for uncomplicated febrile UTI in children demonstrating clinical improvement, supported by the STOP trial, although the SCOUT trial did not meet its noninferiority margin despite a low absolute failure rate; 3 to 5 days was appropriate for uncomplicated cystitis. Antibiotic prophylaxis was not indicated in children with a normal urinary tract following a first febrile UTI and should be reserved for specific high-risk subgroups, with nitrofurantoin as the preferred agent. Formal antibiotic stewardship programs combining prospective audit and feedback, electronic health record integration, and prescriber education demonstrated measurable improvements in prescribing appropriateness for pediatric UTI. Gepotidacin, a first-in-class oral antibiotic approved in 2025 for uncomplicated UTI in female patients aged 12 years and older and weighing at least 40 kg, represented a limited option for eligible adolescents with resistant infections. Conclusions: Antibiotic stewardship for pediatric UTI addresses the full clinical pathway from diagnostic stewardship through prophylaxis rationalization. Evidence-based interventions targeting urine collection, urinalysis-guided decision-making, early intravenous-to-oral transition, duration optimization, and selective prophylaxis use can collectively reduce unnecessary antibiotic exposure without compromising patient outcomes. A dedicated stewardship-oriented pediatric UTI guideline, standardized resistance surveillance, and multicenter stewardship program evaluations with patient-centered outcomes are critical research priorities. Full article

This paper investigates the problem of non-fragile dissipative filtering for discrete-time nonlinear networked systems with dynamic quantization, a dynamic event-triggered mechanism and stochastic cyber attacks. The nonlinear networked system under investigation is described by an uncertain Takagi–Sugeno (T-S) fuzzy model. In this work, a novel fuzzy-dependent dynamic event-triggered communication scheme and the dynamic quantization strategy, integrated with an online adjustment rule, are introduced to reduce the frequency and volume of data transmission, thus realizing more rational utilization of the limited communication resources. In addition, the stochastic cyber attacks are characterized by a random variable obeying the Bernoulli distribution. The core focus of this paper is to design a non-fragile filter such that the resulting filtering error system is stochastically stable and meets the prescribed dissipative filtering performance. Based on the matrix inequality decoupling technique, the design conditions of the desired filter are derived and presented in the form of linear matrix inequalities (LMIs). Finally, the effectiveness and superiority of the proposed filter design approach is verified via two simulation examples. Full article

This study investigates the inverse estimation of the effective thermal diffusivity of a polytetrafluoroethylene (PTFE) plate subjected to oscillatory heating from a hot plate with on–off control. Transient temperature measurements at four internal positions were used to evaluate three modeling strategies: a constant-diffusivity formulation with a prescribed Dirichlet boundary condition, a position-dependent effective diffusivity formulation, (x), and a constant-diffusivity model with a Robin boundary condition to account for thermal contact resistance. The constant-diffusivity Dirichlet model, when fitted to all data simultaneously, was unable to reproduce the experimental thermal response satisfactorily. When fitted separately at each thermocouple position, the estimated effective diffusivity increased systematically with position change, indicating that the experimental response could not be represented by a single scalar parameter under the adopted Dirichlet formulation. Variable-(x) models improved the fit, especially the exponential and rational expressions, which reproduced the apparent saturating spatial trend more effectively. However, these functions should be interpreted as empirical effective representations rather than intrinsic constitutive laws for PTFE. The Robin-boundary model with constant diffusivity also provided a comparable fit, suggesting that interfacial thermal resistance at the PTFE–hot plate contact may explain part of the apparent spatial variation inferred by the Dirichlet models. These results indicate that internal temperature measurements under realistic transient heating are not sufficient to uniquely distinguish between distributed effective diffusivity and boundary-contact resistance effects. Therefore, the estimated diffusivity values should be interpreted as model-dependent effective parameters rather than direct measurements of intrinsic PTFE thermal diffusivity. Full article

Background: Antimicrobial stewardship programs (ASPs) are critical for promoting rational antibiotic use. While early implementation outcomes have been reported, extended follow-up sustainability and the impact on high-priority broad-spectrum antibiotics in South Korean secondary/tertiary hospitals require further validation. This study aimed to evaluate the extended outcomes and sustainability of an ASP over a 14-month period. Methods: This retrospective, single-center study analyzed ASP activities from January 2025 to February 2026 at a tertiary hospital in South Korea. Interventions included prospective audit and feedback (PAF) for restricted antibiotics and recommendations for prolonged prescriptions (≥14 days). Primary outcomes were the monthly rejection rate of restricted antibiotics and the acceptance rate of ASP interventions. Secondary outcomes included the days of therapy (DOT) per 1000 patient–days for meropenem and piperacillin/tazobactam (Pip/Taz). Results: During the 14-month period, the ASP intervention acceptance rate increased significantly from a mean of 72.0% in the implementation phase (January–April 2025) to 81.2% in the stabilization phase (May 2025–February 2026) (p = 0.035). The DOT for Pip/Taz decreased significantly from 169.4 to 151.8 per 1000 patient–days (p = 0.002), with a significant negative correlation identified between the intervention acceptance rate and Pip/Taz consumption (r = −0.625, p = 0.017). Although overall meropenem DOT showed seasonal fluctuations without reaching statistical significance across phases, a year-over-year comparison revealed a 7.5% reduction in meropenem DOT (January–February 2025: 54.8 vs. January–February 2026: 50.7 per 1000 patient–days). The rejection rate for restricted antibiotics declined from 3.8% to 2.6%, suggesting that clinicians increasingly self-regulated inappropriate prescribing attempts. Conclusions: The ASP demonstrated extended follow-up sustainability with a significant reduction in the consumption of key broad-spectrum antibiotics. A progressive increase in clinician acceptance of ASP interventions from 72.0% to 81.2%, combined with a concurrent decline in the restricted antibiotic rejection rate, reflected a measurable shift in institutional prescribing culture and confirmed the successful transition to a stabilized program. These findings support the necessity of sustained multidisciplinary ASPs, even in resource-limited settings, to combat antimicrobial resistance effectively. Full article

Benzodiazepines (BZDs) are among the most widely prescribed psychotropic drugs in modern healthcare, primarily used as anxiolytics, hypnotics, anticonvulsants, and muscle relaxants. However, rising global consumption and prolonged use raise significant concerns about safety and dependence. Recent studies report that up to 35.8% of patients continue BZD therapy beyond three months, with long-term use observed in over 5% of the general population. These patterns highlight the need for evidence-based strategies to improve prescribing practices. BZDs are recommended primarily for short-term management of severe anxiety or transient insomnia, typically limited to 2–4 weeks. In anxiety disorders, SSRIs and SNRIs are first-line treatments. BZD use is particularly discouraged in older adults due to increased risks of cognitive impairment, falls, and dependence. Rational prescribing requires individualized assessment, minimal effective dosing, gradual withdrawal protocols, and patient education. Enhanced regulatory oversight and improved access to psychotherapy are essential for safer benzodiazepine use. Full article

(1) Background: Metabolic disorders, including hypertension, hyperlipidemia, and hyperglycemia (HHH), rank at the top of the disease burden in China. However, population-level assessment of pharmacological treatment remains limited by the lack of scalable metrics for monitoring medication use and outcomes. (2) Methods: We pioneered the use of standardized combined “HHH” medication usage—encompassing antihypertensive, antidiabetic, and lipid-lowering agents—as an integrated proxy for evaluating interventions for cardiovascular diseases and diabetes. Leveraging wastewater-based epidemiology (WBE), we quantified HHH medication loads (mg/d/1000 persons) across 30 prefectures covering all regions in China, and mapped the associated geographical disparities using independent t-tests. Associations with environmental, socioeconomic, demographic, social service, and health-related behavioral and lifestyle factors were further examined via correlation analysis. (3) Results: Our findings confirmed a pronounced north–south gradient in HHH medication uses (the mean standardized loads in the north were approximately twice as high as those in the south, p < 0.05). Furthermore, aging, sex ratio, nicotine consumption, obesity rate, the comprehensive Air Quality Index (AQI), precipitation and the Urban Wellness and Healthcare Index were identified as the top seven influencing factors (|r| values ranging from 0.37 to 0.71, all p < 0.05). (4) Conclusions: As a comprehensive national-scale analysis of multi-drug use for HHH via WBE, this study provides valuable insights into national multi-disease pharmacological treatment, offering evidence-based support for refining clinical prescribing guidelines and rationalizing the allocation of healthcare resources. Full article

Background: Antibiotic resistance (ABR) is a critical global health threat, disproportionately affecting low- and middle-income countries (LMICs) where systemic constraints, economic pressures and sociocultural factors drive inappropriate antibiotic use. While quantitative studies describe prevalence patterns, they fail to capture the underlying motivations and contextual barriers influencing prescribing and dispensing behaviors. This systematic review synthesizes qualitative evidence on the perceptions of healthcare professionals, patients, and caregivers regarding antibiotic use and explores the barriers and facilitators for implementing antibiotic stewardship programs in LMIC healthcare settings. Methods: We conducted a systematic review following PRISMA 2020 guidelines, based on a registered protocol in PROSPERO ID: CRD42024583749. Searches were performed in Medline, Embase, Cochrane Library, Web of Science, and Google Scholar for English-language studies published between 2014 and 2024. Qualitative and mixed-method studies examining stakeholder perspectives on antibiotic use and antibiotic stewardship implementation in LMICs were included. Studies were excluded if they focused exclusively on pediatric or neonatal populations, veterinary medicine, or quantitative outcomes without qualitative components. The data were analyzed using thematic analysis to identify and categorize codes and identify themes following methodological quality assessment of included studies using the Critical Appraisal Skills Programme Qualitative Studies Checklist by two independent reviewers. Results: Out of 2214 studies screened, a total of 119 studies from 33 LMICs were included, encompassing over 4000 participants across hospital, primary care, and community settings. Five interlinked themes emerged: (1) antibiotic use as a pragmatic response to diagnostic uncertainty and resource constraints; (2) financial and commercial drivers shaping prescribing and dispensing practices; (3) the disconnect between knowledge, sociocultural norms, and clinical behavior; (4) multi-level structural and professional barriers to antibiotic stewardship implementation; and (5) the critical role of health system vulnerabilities in perpetuating misuse. Conclusions: Inappropriate antibiotic use in LMICs reflects rational adaptations to systemic limitations rather than isolated knowledge gaps. Effective ABS strategies must address structural deficiencies, economic incentives, and sociocultural norms, while integrating context-specific interventions that strengthen health systems and engage all levels of care. The findings should, however, be evaluated in light of the geographic unevenness of the evidence base, the exclusion of non-English and gray literature, and lack of certainty assessments for synthesized themes. Full article

Anti-inflammatory agents, antipyretics, and antibiotics are commonly used to manage fever and pain associated with infectious diseases in both adults and children. Despite their effectiveness, inappropriate and unnecessary prescriptions remain widespread, leading to adverse patient outcomes and, in the case of antibiotics, contributing to antimicrobial resistance. Addressing these issues requires effective stewardship programs focused on educating healthcare professionals and the public on evidence-based guidelines for optimal prescribing practices. This paper explores the five “A”s fundamental to infection management in pediatric and adult patients: appropriateness, abuse, antipyretics, anti-inflammatory agents, and antibiotics. Through a comprehensive literature review, expert perspectives, and clinical guidelines, the study evaluates the roles of anti-inflammatory agents (e.g., ibuprofen), antipyretics (e.g., paracetamol), and antibiotics in clinical practice, highlighting best practices for their use. Current guidelines emphasize that antipyretics should only be administered when fever is accompanied by significant discomfort or pain, as fever itself plays a role in the immune response. Based on the available literature, experts also suggest that paracetamol should be preferred as a first-line antipyretic due to its favorable safety profile, while ibuprofen should be used with caution, particularly during respiratory infections, varicella, and severe bacterial infections, due to its potential to exacerbate complications. According to experts, special consideration is also required for patients with renal or gastrointestinal comorbidities to prevent toxicity. Regarding antibiotics, prescriptions should be limited to clear evidence of bacterial infection to avoid unnecessary patient exposure and the development of antimicrobial resistance. Stewardship programs underscore the importance of selecting the right agent, optimizing dosing, and introducing shorter treatment regimens where supported by evidence, to improve therapeutic outcomes while minimizing resistance risks. Ultimately, this paper provides practical, evidence-based recommendations to support rational prescribing of antipyretics, anti-inflammatory drugs, and antibiotics, aiming to optimize patient outcomes, prevent unnecessary toxicity, and contribute to global efforts against antimicrobial resistance. Full article

In this paper, the uniform approximation of continuous functions on $[0,1]$ by rational functions with prescribed poles and bounded multiplicities is studied. A classical theorem of Fichera characterizes density in $C\left(\right[0,1\left]\right)$ through the divergence of a conformally invariant series involving the pole distribution. A modern reformulation of this result is developed and it is given an operator-theoretic interpretation in which the approximation property is equivalent to cyclicity and to the absence of nontrivial invariant subspaces in an associated Hardy-space model. In this framework, the classical Blaschke condition emerges as the fundamental obstruction to density, linking rational approximation to the structure of model spaces and non-selfadjoint operator algebras. The density criterion is interpreted in terms of symmetry: divergence corresponds to a balanced distribution of poles compatible with the conformal geometry of the slit domain, while convergence induces symmetry breaking and the emergence of invariant structures. Numerical models illustrate the sharpness of the criterion and provide a concrete manifestation of the Blaschke obstruction and cyclicity mechanism. This new approach places Fichera’s theorem within a broader operator-theoretic and spectral framework, connecting classical approximation theory with Hardy spaces, invariant subspace theory, and modern rational approximation methods. Full article

In contemporary multi-family housing construction, the structural grid is often influenced or conditionally determined by the dimensional logic of underground parking garages. When transferred to above-ground storeys, it directly defines façade frontage, building depth, and possibilities for apartment organisation. Previous research has mostly examined housing typology, dimensional standards, and structural systems as separate domains, while the influence of parking-derived structural grids has not been systematically analysed within a unified framework. This paper applies an analytical-comparative approach, comparing typical structural grids derived from parking modules with the minimum façade frontages required for different apartment types. The method includes identifying characteristic grid dimensions, defining minimum façade frontages based on normatively prescribed room widths, calculating deviations between required and available dimensions, and analysing individual and combined apartment units according to the criterion of minimal positive deviation, within the Serbian regulatory framework. The results show that the structural grid is a relevant factor in apartment organisation and typological structure. Certain grids enable more rational layouts with minimal spatial adjustments, while others generate dimensional surplus, excessive depth, or typological constraints. The study establishes a link between parking modules, structural grids, and apartment organisation, and proposes an analytical framework for evaluating their dimensional compatibility in multi-family housing design. Full article

Background: Antimicrobial resistance continues to threaten effective infection management worldwide and is driven largely by inappropriate prescribing practices. In Saudi Arabia, the cities of Makkah and Al-Madinah experience intense seasonal healthcare demand due to the annual pilgrimage, creating additional challenges for rational antibiotic use. This study aimed to evaluate physicians’ knowledge, attitudes, and prescribing behaviors related to antibiotics in these high-demand settings. Methods: A cross-sectional analytic study was conducted between June and August 2024 among physicians practicing in Makkah and Al-Madinah, including those participating in Hajj services. A previously validated, structured electronic questionnaire assessed knowledge of common pathogens, perceptions of antimicrobial resistance, prescribing influences, and counseling practices. The survey was distributed electronically to eligible physicians. Descriptive statistics were generated, and associations were examined using appropriate inferential tests with a 95% confidence level. Results: A total of 487 physicians participated. Most respondents (74%) correctly identified major bacterial causes of upper respiratory tract infections, and 90% acknowledged the association between prior antibiotic exposure and resistance. Nonetheless, misconceptions persisted regarding the benefit of antibiotics in viral conditions. Workload and patient expectations influenced prescribing behavior; 77% reported a greater likelihood of prescribing antibiotics during periods of high clinical pressure. While adherence to guideline-based practice was generally reported, variability existed in counseling practices and perceptions of stewardship policies. Conclusions: Although baseline knowledge was satisfactory, contextual and behavioral factors continue to influence prescribing decisions and may contribute to unnecessary antibiotic exposure, highlighting the need for strengthened antimicrobial stewardship strategies in high-demand healthcare environments. Full article