A recent study looked at 931,015 English primary care consultations which took place between 2013 and 2015 and ended in an antibiotic prescription. Of those people receiving antibiotics, the majority were prescribed a course that was longer than recommended in NICE guidance.

NICE have reviewed the study published in the BMJ in a new medicine’s evidence commentary which evaluates new evidence and highlights areas for improvement in clinical practice. The findings suggest that guidance on antibiotic use is not being implemented as well as it could be in all areas which may lead to antibiotic overuse.

Global threat

Antibiotic resistance is a global threat and one that is growing at alarming speed. The link between antibiotic prescribing and resistance is clear.

In 2019, the government published their 5-year action plan and 20-year vision which details how the UK will address antimicrobial resistance. Aims include reducing human antibiotic use by 15% and cutting the number of resistant infections by 10% before 2025.

Common Infections

The authors of this latest research looked at prescriptions for acute cough, sore throat, sinusitis, cellulitis and pneumonia amongst other common infections. They noted that prescriptions regularly exceeded the recommended duration as outlined in NICE guidance.

On average, people were spending an extra two days on antibiotics for bronchitis and four additional days for acute cystitis when compared with the duration advised within NICE guidance. Overall, people spent a combined total of 1.3m additional days on antibiotics. The recommended course for these medicines can be found in the NICE summary of antimicrobial prescribing guidance for a range of common infections.

NICE recommendations

NICE and PHE have jointly published antimicrobial prescribing guidelines for a range of common infection topics, which include recommendations on the choice, dosage and course length of antibiotics. The guidance reminds prescribers use the shortest effective course.

NICE has also published guidance on antimicrobial stewardship which aims to change prescribing practice and advise practitioners, carers and the general public to protect current antibiotics and ensure their effectivity for years to come.

Dr Tessa Lewis, GP and chair of the managing common infections guidance committee, said:

“This study provides a useful insight into antibiotic prescribing in general practice. As a GP the decision about whether to prescribe an antibiotic can be complex, however deciding on the course length is usually more straightforward, especially for respiratory infections. It can be a challenge keeping up to date with changing guidance, so this study is a reminder for prescribers to check their current practice. Course length is an important area for antimicrobial stewardship.