Antimicrobials have revolutionised clinical care, but their use and misuse has contributed to the current drug-resistance emergency. The prescription of antimicrobials demand that prescribers demonstrate technical skills such as knowledge about pharmacokinetic and pharmacodynamics, up-to-date awareness of emerging infections and understanding of local and national drug susceptibility. In addition to these skills, prescribers must also demonstrate optimal and effective communication with patients, particularly when antibiotics are not warranted. These ‘softer’ skills are essential to balance the influence of social or cultural factors on decisions by all stakeholders involved in antibiotic usage. To balance these demands, prescribers can engage in systematic decision making that reflects upon the need and benefits of using antimicrobials. This will ensure that optimal diagnostic and imaging tests inform such decisions; following recognised guidance and best practice, whilst acknowledging the local drug susceptibilities and available resources; and engage and support patients and families to share decisions about antibiotic use and follow-up care.