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80% of GP antibiotic prescriptions for respiratory conditions 'are too long'

Antibiotics are being prescribed by GPs for longer course times than guidelines advise, with 80% of prescriptions for respiratory conditions exceeding recommended timeframes, new research claims.

Researchers from Public Health England (PHE), the University of Oxford and the Brighton and Sussex Medical School analysed almost 1m consultations that led to oral antibiotics being prescribed across 13 conditions and found the duration was a cumulative 1.3m days beyond the timeframes recommended by PHE at the time. 

The study, published in the BMJ, looked at consultations that took place between 2013 and 2015 and found that respiratory conditions were most likely to lead to excessive course durations. 

GP leaders said the profession was under ‘huge pressure’ to reduce antibiotic prescribing and that it was important to decrease course lengths where possible.

But they added it was ‘extremely challenging’ balancing this with situations where the decision to prescribe antibiotics or not could mean ‘life or death’ for patients.

The study found that prescriptions for acute cough and bronchitis that exceeded guidelines typically lasted two days beyond the recommended five days.

Similarly, for acute sinusitis, those prescriptions that went against guidance were on average three days longer than the recommended seven-day course.

However, for some conditions shorter courses were prescribed. Over half (52.3%) of courses were shorter than the recommended 28 days for acute prostatitis and nearly a third (31.8%) of acute cystitis treatments for men were under the suggested seven days.

PHE said it encourages GPs to consider revised guidelines when prescribing to ‘help drive antibiotic consumption and tackle antibiotic resistance’.

The study authors said 'poor guideline adherence may result from several factors, including lack of awareness and scepticism of specific guideline recommendations’ but noted more research is needed to understand why clinicians prescribe antibiotic courses for longer than is recommended.

Commenting on the findings, the BMA’s GP Committee clinical and prescribing lead Dr Andrew Green said: ‘Over recent years, the length of courses recommended for many common infections has decreased and publicising these changes is important.

‘This is an evolving area of medicine and GPs need to be aware that traditional approaches, such as long courses of penicillin for strep sore throat, or even advising the patient to always complete an antibiotic course, are being reviewed.’

RCGP chair Helen Stokes-Lampard said: 'GPs are in an incredibly difficult position when it comes to antibiotics prescribing. We are under huge pressure not to prescribe - and publicly vilified when we are deemed to do so too readily - yet, we know that in some cases antibiotics are a matter of life or death.

’Getting the balance right every time is extremely challenging. GPs in the UK are doing an excellent job of reducing antibiotics prescribing overall - but our priority will always be the patient in our consultation room, and we will prescribe based on the unique combination of factors potentially affecting that patient’s health at that time.'

PHE's deputy director of the national infections service, Dr Susan Hopkins, said: 'In many cases an antibiotic may not be necessary, but in cases where the clinician feels it is appropriate to prescribe, we now know that a shorter course of antibiotics is both effective and safe for many common conditions.

'We encourage GPs to take the revised NICE PHE guidelines into account when prescribing in order to help drive down antibiotic consumption and tackle antibiotic resistance.'

Pulse previously reported that GPs with a higher workload tend to prescribe more antibiotics.

GPs were told last year they may have to use point-of-care diagnostics before prescribing antibiotics as part of an NHS England campaign to reduce consumption.

Meanwhile, a new data tool launched in Manchester will soon allow GPs to compare their antibiotic prescribing against national rates.

Related images

  • Antibiotics prescription 3x2

Readers' comments (12)

  • Experienced doctors have learnt that the guidelines are useless. If you give a short course the symptoms will not have resolved by the time punters have finished the course. They come back. Giving more will not help, but you soon learn the explanation is wasted on 98%+.

    The uti guidelines are even worse, as many women will simply not get better with only 3 days of antibiotic.

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  • Agree with stelvio. you may clear a uti bug in 24 hrs but sx don't settle for 4-5 days. worse with the "Old Chest infection Doc.." It has always seemed very arbitrary how long a course of abx should be. Why not just advise patients to take treatment until they feel better? After all how many "Courses" are ever completed for the full length issued no matter what the current guideline is?

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  • Think of those who need to pay for prescriptions. Give 5 days course and if no better give another 2 days so patient
    Pays twice and grumbles on unnecessary cost.

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  • They do come back if you give 5 days. A GP appointment is of course "free".

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  • Agree with all the above,pound to a penny all the prawn sandwich, power point and 2 session/secondary-care guidelines meeting jockeys don't do much front-line work and get down and dirty like the rest of us burnt out counting down to vacating this mess grunts.So we will carry on doing what works.They never ask the punters what they want as is evident from the current direction of travel.

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  • Comrades, we are all speaking with the same voice!

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  • Cats do flock together!

    Next week will be Sepsis Week and wicked GPs to blame for not giving enough antibiotics.

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  • They just sodding come back!!! Prescribing 3/5 days instead of 7 just leads to an increased workload for the GP practice or the OOH service, so that's why we do it PHE or whoever is moaning about GPs this week....

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  • We are all agreeing! Who writes these guidelines?

    3 day course of UTI don't work - generate multiple appointments. I've never met a GP yet who agrees.

    Only OOH services and Pharmacists give 3 day courses- but they never have to see patients again -they come to us.


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  • and who mandates that respiratory antobiotics come in 7-day pack sizes? - the DoH.
    And who actually directs them for COPD patients? - the Consultants, Duh! they like their pateitns to have 7 days' worth every 2 weeks, just to keep them from going back to OPD.

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