Intended for healthcare professionals

  1. Alastair D Hay, professor
  1. Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, Bristol BS8 2PS, UK
  1. alastair.hay{at}

New evidence on when to prescribe, and for how long

Primary care is responsible for around 80% of all antibiotic prescribing in the UK’s National Health Service,1 with rates likely to be similar worldwide. Two studies in The BMJ add to the growing evidence base informing policy on antimicrobial stewardship, which has helped primary care clinicians reduce prescribing by 13% in the past five years1 without increasing serious complications, including sepsis.2 But the studies also highlight the daily challenge of ensuring that patients who are unlikely to benefit are not treated, whereas those who require antibiotics receive the right class, at the right time, at the right dose, and for the right duration. This task is made considerably more difficult by the absence of real-time microbiology in primary care.

Both studies use invaluable routine NHS data. The first of the studies, by Gharbi and colleagues (doi:10.1136/bmj.l525), explores the effect on bloodstream infections of different primary care antibiotic prescribing strategies for urinary tract infections (UTIs) in older people.3 This study is one of a growing number of studies investigating the relation between prescribing in primary care and serious infections,4 and …

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