Delayed prescribing of antibiotics for self-limiting respiratory tract infections in an urgent care out-of-hours setting

Continued inappropriate prescribing alongside the overuse of antibiotics has caused the widespread development of antimicrobial resistance (AMR) (Public Health England (PHE), 2015). Global deaths due to infections as a result of AMR are estimated at 700 000 each year, and this figure is predicted to rise (World Health Organization, 2018). The Department of Health and Social Care (DHSC) recently published a five-year national action plan, aiming to reduce antibiotic prescriptions and improve prescribing practice (DHSC, 2019). The NHS Long Term Plan, also aims to optimise antibiotic use and reduce unintentional exposure, through a combination of antibiotic stewardship and leadership at all levels (NHS, 2019). This is particularly pertinent when practising as an advanced nurse practitioner (ANP).

Acute respiratory tract infection (RTI) is one of the most common presentations in primary care (National Institute for Health Care Excellence (NICE), 2008). RTIs include the common cold, sore throat, otitis media, cough, tonsillitis, pharyngitis, rhinosinusitis, and bronchitis (NICE, 2008). Out-of-hours (OOH) is an integral service to primary care; 16.7% of prescriptions are issued for RTI, therefore OOH prescribers contribute significantly to general antibiotic consumption (Lindberg et al, 2017). Patients with viral RTIs rarely need antibiotics, as they are generally self-limiting, unless there is an underlying comorbidity (Huang et al, 2013; NICE, 2008; PHE, 2019). Prescribing antibiotics unnecessarily drains NHS resources and creates the risk of serious outcomes for patient health, including associated side effects and AMR (Costelloe et al, 2010). Furthermore, inappropriate use of antibiotics and beliefs about the effectiveness of antibiotics encourage patients to re-consult, thereby reducing the probability of self-management (Williamson et al, 2006). PHE recently published research indicating that 20% of antibiotic prescribing in primary care is inappropriate (Davies, 2018). An immediate 10% reduction of prescribing is required to meet the government target, which aims to reduce antibiotic prescriptions by 50% by the end of 2020 (DHSC, 2019).