The key message in the new NICE guidance on antibiotic prescribing for respiratory tract infections is clear—the comprehensive reviews of the existing evidence base confirm that antibiotic treatment does not bring meaningful benefits for most patients.1 For most clinicians this will not be a new message, and indeed most will agree with the need for change and will already have made some changes to the way they manage these infections. But old habits die hard, and we in the United Kingdom still (unjustifiably) prescribe almost double the amount of antibiotics prescribed in, for example, Dutch primary care.2 Further progress is hampered by two main clinical challenges: how to identify accurately the few patients who are likely to develop serious illness or whose symptoms could be meaningfully ameliorated by prompt antibiotic treatment, and how to implement efficiently an evidence based prescribing decision while responding to patients’ concerns and expectations in the time constraints of real life general practice.3

The guideline …