The reasons for the frequent and unnecessary use of antibiotics for "chest infections" in primary care are two-fold.

First, the widespread ignorance of the fact that upper respiratory tract viral infections result in lower respiratory tract inflammation. Approximately 30% of indivuals will over a lifetime, usually suffer airway symptoms in response to an upper respriatory tract infection. The famous person in whom this happened repeatedly was Winston Churchill, as described by his physician, Lord Moran in his biography of his patient.
The airway symptoms concerned are one or more of the following. Chest tightness, chest pain, cough, sputum which may be purulent, wheeze and shortness of breath. These symptoms can be distressing and can last for a week or two but may persist for much longer.

The frequent and unnecessary use of antibiotics results from the failure to treat these symptoms quickly and effectively in a patient who has also been told he has a "chest infection".

The second reason for the misuse of antibiotics is the widespread ignorance of the fact that anti-asthma treatment, even topical steroids in adequate doses, will speed up the treatment of these symptoms.

I would be very surprised if this understanding and approach were achieved in primary care, the reduction in antibiotic prescribing in "chest infections" wasn't many times more than the 4.2% reduction achieved by Butler in a rather complicated and expensive controlled trial that he conducted in primary care practices in South Wales.

Competing interests: None declared