Intended for healthcare professionals


Contribution of behavioural science to antibiotic stewardship

BMJ 2015; 350 doi: (Published 25 June 2015) Cite this as: BMJ 2015;350:h3413
  1. Sarah Tonkin-Crine, health psychologist1,
  2. Ann Sarah Walker, professor of medical statistics and epidemiology2,
  3. Chris C Butler, professor of primary care3
  1. 1National Institute of Health Research Health Protection Research Unit, University of Oxford, Oxford OX2 6GG, UK
  2. 2Nuffield Department of Medicine, University of Oxford
  3. 3Nuffield Department of Primary Care Health Sciences, University of Oxford
  1. Correspondence to: Sarah Tonkin-Crine sarah.tonkin-crine{at}

Belated recognition of its importance

The prospect of a world without effective antibiotics has galvanised public and professional opinion on the need to conserve our precious, shared resource of effective antimicrobials.1 Unfortunately, how to do this most effectively is far from clear. Just as with climate change, the threat seems for most people to be largely societal and in the future—exemplifying the so called “tragedy of the commons” (where individual action to maximise personal benefit results in harm to the interests of the population as a whole2). While many people are already experiencing the negative consequences of antimicrobial resistance, taking remedial action has perceived adverse consequences now, with many patients wanting the strongest possible antibiotic to cure their current infection.

Antimicrobial stewardship programmes have been designed to promote the most effective use of antimicrobials by limiting overuse, underuse, or misuse. In the UK, example programmes include the TARGET toolkit for primary care3 and the “start smart then focus” programme for secondary care.4


The prescription of potentially unnecessary antibiotics is one target of these programmes. Most antibiotics are prescribed in primary care for suspected infections, …

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