الرد على المحكّمين بعد طلب تعديلات كبيرة

Thank you for the opportunity to revise our manuscript, “Antibiotic prescribing for acute respiratory infections in 18 primary care centres in Lebanon” (PRCA-D-26-00412). We are grateful to both reviewers for their careful reading. We have addressed every comment below. Changes are highlighted in the revised manuscript, and page and line numbers refer to that version1.

Comment 1.1: “The authors should explain how they handled patients who received antibiotics for a second diagnosis.”
Response: Visits with a second, bacterial diagnosis, such as otitis media alongside a cold, were excluded from the main analysis because an antibiotic could be appropriate for them. We now state this explicitly, and we have added a sensitivity analysis that includes these 112 visits; the results did not change materially2.
Change: Methods, page 6, lines 120–128; new Table S2.

Comment 1.2: “The sample of 18 centres seems small to generalise to the whole country.”
Response: We agree that the size of the sample limits generalisation3, and we have made this clearer. The centres were, however, selected by stratified random sampling from every governorate within the national primary care network, so the sample is broader than its size may suggest. We now state that our findings apply to centres in that network and not to private clinics, and we discuss this in the limitations.
Change: Methods, page 5, lines 98–104; Limitations, page 14, lines 301–306.

Comment 2.1: “Please report the inter-rater agreement for the classification of prescriptions.”
Response: Thank you; this was an omission.4 Two investigators independently classified a random 10% of prescriptions (n = 214), and agreement was high (Cohen’s kappa 0.84). Disagreements were resolved by discussion.
Change: Methods, page 7, lines 141–145.

Comment 2.2: “The discussion overstates the role of patient pressure, which was not measured.”
Response: We agree. Patient pressure was not measured in this study, and our discussion went beyond the data5. We have rewritten the paragraph to present patient expectations as one possible explanation and as a question for future research that measures them directly.
Change: Discussion, page 13, lines 270–281.6