Prescribing antibiotics in general practice

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6942.1511 (Published 04 June 1994) Cite this as: BMJ 1994;308:1511
  1. W Howe
  1. Department of Epidemiology and Public Health Medicine, University of Bristol, Bristol BS8 2PR.

    EDITOR, - Conrad M Harris and David C E F Lloyd have tried to address an important issue for general practitioners considering their antibiotic prescribing behaviour.1 Their work, however, is descriptive, and no firm conclusions should be drawn from it on the optimum treatment of infections (often respiratory) in general practice.

    I was intrigued to read that a five day course of phenoxymethylpenicillin was more common than a seven day course. Can anyone tell me why? I have tried to trace the evolution of prescriptions for five days of phenoxymethylpenicillin and have found references to intramuscular treatment during an epidemic of infection with group A β haemolytic streptococci in American servicemen,2 and the subsequent use of oral penicillin for 10 days,3 for which recommendations persist in the United States.4 The reason for the final transition from 10 to five days eludes me.

    The authors' comments that five days' treatment could save money have received attention in some general practice magazines.5 But the authors make no reference to the effectiveness of the treatments they describe. To conclude that the most commonly prescribed treatment is the most appropriate treatment is based on a false premise - that the majority knows what it is doing.

    I have spent the past 12 months trying to contribute to the question of efficacy by asking general practitioners in Avon to take part in a randomised controlled trial comparing antibiotic with placebo for the treatment of sore throats. Interestingly, we have used a five day course of phenoxymethylpenicillin. I hope to report whether this is effective later this year.


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