Objective To explore and describe perceptions of antibiotic prescribing among Swedish hospital physicians, with special reference to whether the perceptions included awareness of antibiotic resistance (AR).

Design A phenomenographic approach was used and data were collected in face-to-face interviews.

Setting Hospitals in seven different counties in central Sweden.

Participants A strategic sample of 20 hospital physicians specialising in internal medicine, surgery or urology.

Main outcome The variation of perceptions of antibiotic prescribing.

Results Five qualitative different perceptions were found. AR was considered in two of the perceptions. Reasons for not considering AR included a dominating focus on the care of the patient combined with lack of focus on restrictive antibiotic use, or uncertainty about how to manage infectious diseases or the pressure from the healthcare organisation. Parallels between the five perceptions and the stages in the transtheoretical model of health behaviour change were seen.

Conclusions In three of the perceptions, AR was not considered when antibiotics were prescribed. Physicians who primarily express these three perceptions do not seem to be prepared to change to restrictive prescribing. Our findings can be useful in designing activities that encourage AR prevention. Organisational changes are also needed.