Objectives: Determinants of inappropriate antibiotic  prescription in the community are not clearly defined. The objective of  this study was to perform a systematic review and meta-analysis  evaluating gender differences in antibiotic prescribing in primary care.

Methods: All  studies analysing antibiotic prescription in primary care were  eligible. PubMed and MEDLINE entries with publication dates from 1976  until December 2013 were searched. The primary outcomes were the  incidence rate ratio (IRR) (measured as DDD/1000 inhabitants/day) and  the prevalence rate ratio (PRR) (measured as prevalence rate/1000  inhabitants) of antimicrobial prescription, stratified by gender, age  and antibiotic class. Random-effects estimates of the IRR and PRR and  standard deviations were calculated.

Results: Overall,  576 articles were reviewed. Eleven studies, comprising a total of 44  333 839 individuals, were included. The studies used data from  prospective national (five studies) or regional (six studies)  surveillance of community pharmacy, insurance or national healthcare  systems. Women were 27% (PRR 1.27 ± 0.12) more likely than men to  receive an antibiotic prescription in their lifetimes. The amount of  antibiotics prescribed to women was 36% (IRR 1.36 ± 0.11) higher than  that prescribed for men in the 16 to 34 years age group and 40% (IRR  1.40 ± 0.03) greater in the 35 to 54 years age group. In particular, the  amounts of cephalosporins and macrolides prescribed to women were 44%  (IRR 1.44 ± 0.30) and 32% (IRR 1.32 ± 0.15) higher, respectively, than  those prescribed for men.

Conclusions: This  meta-analysis shows that women in the 16 to 54 years age group receive a  significantly higher number of prescriptions of cephalosporins and  macrolides in primary care than men do. Prospective studies are needed  to address reasons for gender inequality in prescription and to  determine whether a difference in adverse events, including resistance  development, also occurs.