Duration of antibiotic treatment for common infections in English primary care: cross sectional analysis and comparison with guidelines
Open accessAbstract
OBJECTIVE: To evaluate the duration of prescriptions for antibiotic treatment for common infections in English primary care and to compare this with guideline recommendations. DESIGN: Cross sectional study. SETTING: General practices contributing to The Health Improvement Network database, 2013-15. PARTICIPANTS: 931 015 consultations that resulted in an antibiotic prescription for one of several indications: acute sinusitis, acute sore throat, acute cough and bronchitis, pneumonia, acute exacerbation of chronic obstructive pulmonary disease (COPD), acute otitis media, acute cystitis, acute prostatitis, pyelonephritis, cellulitis, impetigo, scarlet fever, and gastroenteritis. MAIN OUTCOME MEASURES: The main outcomes were the percentage of antibiotic prescriptions with a duration exceeding the guideline recommendation and the total number of days beyond the recommended duration for each indication. RESULTS: The most common reasons for antibiotics being prescribed were acute cough and bronchitis (386 972, 41.6% of the included consultations), acute sore throat (239 231, 25.7%), acute otitis media (83 054, 8.9%), and acute sinusitis (76 683, 8.2%). Antibiotic treatments for upper respiratory tract indications and acute cough and bronchitis accounted for more than two thirds of the total prescriptions considered, and 80% or more of these treatment courses exceeded guideline recommendations. Notable exceptions were acute sinusitis, where only 9.6% (95% confidence interval 9.4% to 9.9%) of prescriptions exceeded seven days and acute sore throat where only 2.1% (2.0% to 2.1%) exceeded 10 days (recent guidance recommends five days). More than half of the antibiotic prescriptions were for longer than guidelines recommend for acute cystitis among females (54.6%, 54.1% to 55.0%). The percentage of antibiotic prescriptions exceeding the recommended duration was lower for most non-respiratory infections. For the 931 015 included consultations resulting in antibiotic prescriptions, about 1.3 million days were beyond the durations recommended by guidelines. CONCLUSION: For most common infections treated in primary care, a substantial proportion of antibiotic prescriptions have durations exceeding those recommended in guidelines. Substantial reductions in antibiotic exposure can be accomplished by aligning antibiotic prescription durations with guidelines.
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The predominant use of the 500/125 mg twice-daily regimen for seven to 10 days in this dataset mirrors global practice patterns reported in stewardship surveillance and observational studies.
“The predominant use of the 500/125 mg twice-daily regimen for seven to 10 days in this dataset mirrors global practice patterns reported in stewardship surveillance and observational studies [10,11].”
From Clinical Outcomes and Real-World Effectiveness of Amoxicillin-Clavulanic Acid Across Indian Healthcare Settings: A Retrospective Multicenter Study (2026) · cites this paper as [11]
The Discussion (‘Comparison with other studies’; page unavailable) says five- or seven-day antibiotic courses were preferred and that similar duration preferences had been observed in other settings. It does not establish a global pattern for the 500/125 mg twice-daily regimen or for seven-to-10-day courses; the study concerns prescriptions in English primary care. (LLM, conf=0.84)
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“The predominant use of the 500/125 mg twice-daily regimen for seven to 10 days in this dataset mirrors global practice patterns reported in stewardship surveillance and observational studies [10,11].”
Less is more when reducing antimicrobial prescribing
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- Authors
- Pouwels, K. B., Hopkins, S., Llewelyn, M. J., Walker, A. S., McNulty, C. A., & Robotham, J. V.
- Affiliations
- University Medical Center Groningen (NL)
- Royal Free London NHS Foundation Trust (GB)
- Brighton and Sussex Medical School (GB)
- National Institute for Health and Care Research (GB)
- Public Health England (GB)
- Corresponding author
- Pouwels, Koen B
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2019-02-27
- Volume
- 364
- Pages
- l440
- ISSN
- 1756-1833 (ISSN-L)
- 0959-8138
- PMC
- PMC6391655
- OpenAlex
- W2917481668
- Cited by
- 126
- References
- 41
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 16 · 2023: 19 · 2022: 18 · 2021: 29 · 2020: 13 · 2019: 13
- FWCI
- 11.86
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by)
- Sussex Research Online (University of Sussex) (submittedVersion, cc-by)
- Sussex Research Online (University of Sussex) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- HighWire Press Open Archive (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- Funders
- National Institute for Health Research Health Protection Research Unit (HPRU-2012-10041)
- National Institute for Health and Care Research (HPRU-2012–10041)
- University of Oxford
- Public Health England (HPRU-2012-10041)
- NIHR Oxford Biomedical Research Centre (HPRU-2012-10041)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- antibiotic prescribing, antibiotic duration, guideline adherence, primary care, acute respiratory infections, acute sore throat, acute sinusitis, acute otitis media, acute cystitis, acute prostatitis, pyelonephritis, cellulitis, impetigo, scarlet fever, gastroenteritis, inappropriate antibiotic use
- MeSH terms
- Acute Disease, Anti-Bacterial Agents, Bacterial Infections, Cross-Sectional Studies, Drug Administration Schedule, England, Female, Humans, Male, Practice Patterns, Physicians', Drug Prescriptions, Primary Health Care, Time Factors, Databases, Factual, Practice Guidelines as Topic, Guideline Adherence
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