RTIs account for around 60% of global antibiotic prescribing and are a key driver of AMR
Researchers from the Universities of Bristol, Bath, King’s College London and the University Medical Center Utrecht have called for a reduction in the use of repeat antibiotic prescriptions in primary care for the same respiratory tract infection (RTI) episode, based on findings from a study.
Published in the Journal of Infection, the study found high rates of repeat within-episode prescriptions for RTI in primary care in England, despite evidence of little benefit.
Accounting for around 60% of antibiotic prescribing in primary care globally, RTIs are caused by viruses and are one of the key drivers of antimicrobial resistance.
The study analysed over 900,000 RTI episodes from clinical records across 530 English general practices.
Researchers found that nearly 30% of adults and 10% of children had received a second course of antibiotics within the same episode of a lower RTI, a chest infection, while 48.3% involved the same antibiotic class.
Previous research has already revealed that for most child and adult patients with chest infections, a single antibiotic course is unlikely to have clinical benefit, which can lead to antibiotic overuse and resistance.
The team also found that factors associated with repeat prescriptions included frequent ITI-related GP visits and prior repeat within-episode RTI antibiotic prescriptions, specifically more frequently identified in both young children aged two years or less and older adults aged 65 years or older.
Alastair Hay, GP and professor, primary care, the Centre for Academic Primary Care, University of Bristol, commented: “It seems implausible that repeat antibiotic courses will have any benefit given that there is clear evidence that children and adults without chronic lung disease do not benefit from a first course of antibiotics, and that the National Institute for Health and Care Excellence recommends five-day antibiotic courses for the severest lower respiratory tract infections, such as pneumonia.”
Arief Lalmohamed, senior lecturer, University Medical Center Utrecht, said: “It’s clear that antimicrobial stewardship interventions must extend beyond initial antibiotic prescriptions to address within-episode repeats.”

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