Abstract Objectives Prescribing antibiotics may reinforce patients' beliefs antibiotics are needed and increase future consultations for similar symptoms. This review determines the effect of antibiotic prescribing for respiratory infections in primary care on future reattendance. Design, setting and participants A systematic review and meta-analysis of randomised controlled trials and cohort studies, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Participants were adults or children presenting with respiratory infection in primary care. Interventions Prescription of antibiotics. Primary outcome measure Reattendance at least 28 days after initial consultation. Method Eligible studies included open-label randomised controlled trials (RCT) or cohort studies of antibiotics compared to no antibiotics in adults or children with respiratory infections. MEDLINE (Ovid), PubMed, Embase, the Cochrane Central Register of Controlled Trials, clinical trial registries and grey literature sources were searched from inception until 6th February 2024. Two reviewers independently screened, selected, assessed quality and extracted data. Separate meta-analyses were presented for RCT and cohort studies. Results We identified 2128 records and reviewed 48 full texts, of which five met inclusion criteria. These reported three RCTs (1207 randomised to antibiotics, 672 controls) and three cohort studies (209,138 exposed to antibiotics, 46,469 controls). In the meta-analysis of randomised trials, relative risk (RR) of reattendance with antibiotics was 1.10 (95%CI: 0.99 to 1.23) and in the cohort studies RR was 1.21 (95%CI: 0.94 to 1.49). An important limitation is that most studies were in UK primary care. Conclusion Evidence suggests prescribing antibiotics for acute respiratory tract infections in primary care probably modestly increases future reattendance for similar conditions. Reducing antibiotic prescribing may help reduce demand for primary care. PROSPERO registration number CRD42023470731

The authors have declared no competing interest.

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Search strategies are included in supplementary materials. The list of included papers is available from the authors on request.