INTRODUCTION:
Upper respiratory tract infections (URTIs) are predominantly viral and self-limiting, yet they remain a leading cause of inappropriate antibiotic use in primary care. This misuse is a significant driver of antimicrobial resistance (AMR) globally. Quantifying current prescribing patterns across different economic regions is essential for designing targeted stewardship interventions and monitoring progress towards global health goals.

METHODS:
We systematically searched Scopus, PubMed, Embase, and Web of Science for observational studies published between January 2015 and December 2025 that reported antibiotic prescribing rates for URTIs in primary care settings. A random-effects meta-analysis was conducted to estimate the pooled prevalence of antibiotic prescribing. Subgroup analyses were performed to evaluate variations based on World Bank country income classifications, patient age groups (pediatric versus adult), and specific clinical diagnoses.

RESULTS:
Thirty-six studies representing over 156,000 patient encounters were included in the final analysis. The global pooled antibiotic prescribing rate for URTIs was 42.5% (95% Confidence Interval: 35.2%-50.1%). Significant geographical disparities were observed: the prescribing rate was 28.0% in high-income countries compared to 65.4% in low- and middle-income countries. Regarding specific diagnoses, acute bronchitis had the highest prescribing rate at 68.0%, followed by pharyngitis at 55.0%, while the common cold had the lowest rate at 18.0%.

CONCLUSIONS:
Despite clinical guidelines discouraging antibiotic use for uncomplicated URTIs, prescribing rates remain alarmingly high worldwide, particularly in resource-limited settings. These findings highlight a critical gap in practice and suggest that antimicrobial stewardship programs must address structural inequities and diagnostic uncertainty to effectively combat antimicrobial resistance.