The median practice issued antibiotic prescriptions at 38% of consultations for ‘colds’, 48% for ‘cough’, 60% for ‘otitis media’ and ‘sore throat’, and 91% for ‘rhino-sinusitis’. However, the highest prescribing 10% of practices issued antibiotic http://www.selleckchem.com/products/Axitinib.html prescriptions at 72% of consultations for ‘colds and URTI’, 67% for ‘cough and bronchitis’, 78% for ‘sore throat’, 90% for ‘otitis-media’ and 100% for ‘rhino-sinusitis’. The lowest prescribing 10% of practices

issued antibiotic prescriptions at 14% of consultations for ‘colds and URTI’, 28% for ‘cough’ and 41% for ‘sore throat’. Discussion National guidance in the UK recommends that most patients presenting with acute RTIs can be managed with either no antibiotic prescribing

or delayed antibiotic prescribing, with a prescription only being used if symptoms do not improve.4 The present results show that most general practices in the UK depart substantially from recommended standards of good practice with respect to antibiotic prescribing in a generally low-risk age range of young and middle-aged adults. Even for common colds and URTIs, which are generally acknowledged to have a viral aetiology, antibiotics may be prescribed for a third of patients overall and for more than 80% of patients at some general practices. A number of trials have now shown that antibiotic prescribing may be reduced through educational interventions, together with feedback of prescribing information.10–12 However, these interventions generally have modest effects with generally less than 10–15% reduction in antibiotic prescribing. As Linder13 has observed, current antibiotic prescribing appears to be ‘way off the mark’ when viewed in the context of systematic review evidence of lack of benefit14 and current recommendations for good clinical practice.4 Our study had the strengths of a large, representative sample of UK general practices. We acknowledge that we did not include information concerning severity of illness or the presence of comorbidity, which might have accounted for the prescription of antibiotics

in some cases. We only analysed prescriptions issued by the practice and it was not possible to estimate from electronic health records whether the prescription was dispensed, or whether a delayed prescribing Cilengitide strategy was intended. There is a Read code for deferred antibiotic therapy (8BP0.00) but this was recorded for fewer than 0.5% of medical events. It is unlikely that delayed prescribing can fully account for the high prescribing rates. In an observational study in 13 000 adults with sore throat, immediate antibiotics were issued in 42% and 12% given delayed antibiotics.15 Delayed prescribing is unlikely to vitiate our conclusion that most UK practices prescribe antibiotics to excess.