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Can we achieve shorter antibiotic courses in primary care?
  1. Michael Wilcock1,
  2. Alastair D Hay2
  1. 1 Pharmacy, Royal Cornwall Hospitals NHS Trust, Truro, UK
  2. 2 Professor of Primary Care, Bristol Medical School, Bristol, Bristol, UK
  1. Correspondence to Michael Wilcock, Pharmacy, Royal Cornwall Hospitals NHS Trust, Truro, UK; mike.wilcock{at}nhs.net

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Around three-quarters of all UK antibiotic prescriptions are issued in the community and the UK Government’s antimicrobial stewardship programme has set a target that by 2024 antibiotic use in the community will have reduced by 25% from the 2013 baseline.1 2 Of all primary care prescribing settings (eg, general practice, dental, other community settings), general practitioners prescribe the majority of items (86% of all antibiotic prescriptions in England in 2019), though antibiotic use in general practice has reduced by 14% since 2015.1 In general practice, there has been a focus on reducing inappropriate prescribing, managing patient expectations around antibiotics and promoting the concept of delayed prescribing.3 However, unlike in secondary care where the ‘Start Smart then Focus’ campaign prompts review of the clinical diagnosis and the continuing need for antibiotics at 48–72 hours, there has been less attention in primary care on limiting the duration of treatment by using shorter courses.4

Current practice

A large cross-sectional study of UK prescribing data found that the duration of antibiotic prescriptions for common infections in primary care frequently exceeded national guideline recommendations.5 For 13 indications combined, there were about 1.3 million days beyond the durations recommended by guidelines, mainly due to respiratory conditions, which accounted for more than two-thirds of prescriptions, and where antibiotics have only modest effects. Fewer prescriptions exceeded the course length recommendations for non-respiratory indications, but more than half of prescriptions (55%) for cystitis in women were longer than …

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Footnotes

  • Competing interests None declared. Refer to the online supplementary files to view the ICMJE form(s).

  • Provenance and peer review Commissioned; externally peer reviewed.

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