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Antibiotic prescribing in primary care – a response to new evidence on when to prescribe and for how long

27 February 2019

Professor Alastair Hay, from the University of Bristol’s Centre for Academic Primary Care, has responded to new research on when and how GPs should prescribe antibiotics for common infections in an editorial published in The British Medical Journal (BMJ) today (Wednesday, 27 February).

Primary care is responsible for around 80 per cent of all health service antibiotic prescribing in the UK, with rates likely to be similar worldwide. The UK government has set targets for reducing antibiotic prescribing because of concerns that the over-use of antibiotics is contributing to antimicrobial resistance, which makes antibiotics less effective or ineffective, posing a serious risk to public health.

Professor Hay’s response is to two studies published in the journal, one which found that delaying or withholding antibiotics for people aged over 65 with symptoms of urinary tract infection (UTI) appears to be associated with higher risk of bloodstream infection (sepsis) and death, and another which found that most antibiotic courses for common infections, such as respiratory infections, exceed new recommended guidelines.

Professor Hay said: “These are two important studies that illustrate the complexity of decision-making for GPs about when and how to prescribe antibiotics. The first suggests that older adults, especially men aged over 85, should start taking antibiotics as soon as possible after diagnosis with a UTI to reduce the risk of serious complications.

"The second, that adhering to national guidance on the length of treatment with antibiotics for common infections would result in around 65 million fewer antibiotic days each year in the UK, significantly reducing the number of antibiotics prescribed through primary care.

“These studies are welcomed as important new evidence to inform antibiotic prescribing policies. While reducing antibiotic course length could be implemented relatively easily, the first study does not provide the causal evidence needed to be confident that current GP practice is harming patients.”

UTIs are the most common bacterial infection in older patients. But concerns about the spread of antibiotic resistance have led to reductions in antibiotic use in England. However, if applied to vulnerable older adults, this decline could lead to harm, since they are more likely to develop UTI-related complications.

Previous studies have found significant over-prescribing of antibiotics in primary care in the UK and elsewhere, with the overuse of antibiotics increasing antibiotic resistance levels and putting patients at risk of side effects.

There has been little research on reducing antibiotic overuse by cutting back on course length, so in the second study researchers from Public Health England (PHE), University of Oxford, and Brighton and Sussex Medical School compared the durations of antibiotic courses prescribed for common infections in English primary care with the guidelines recommended by PHE in 2013.

Read Professor Hay’s editorial in the BMJ.


Antibiotic management of urinary tract infection in the elderly in primary care and its association with bloodstream infections and all-cause mortality: a population-based cohort study in the BMJ

Duration of antibiotic treatment for common infections in English primary care: cross sectional analysis and comparison with guidelines in The BMJ

Corresponding editorial:

Antibiotic prescribing in primary care in the BMJ

Further information

About the Centre for Academic Primary Care

The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow us on Twitter: @capcbristol.

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