Addressing long-term and repeat antibiotic prescriptions in primary care: considerations for a behavioural approach

Overprescribing of antibiotics in primary care is one of the important drivers of antimicrobial resistance (AMR) internationally.1 Previous studies estimated that one-fifth to one-third of UK antibiotic prescriptions in primary care are unnecessary or inappropriate.2 The study by van Staa and colleagues3 published in this issue of BMJ Quality & Safety delivers additional insights into prescribing practices by primary care physicians (general practitioners, GPs) in the UK. Analysing data from more than 6000 GPs in 466 general practices between 2012 and 2017, they found large variability in prescribing practices as measured, for example, by the overall antibiotic prescribing rate per consultation, the percentage of patients receiving repeat prescriptions and the use of broad-spectrum antibiotics. The percentage of repeat prescriptions (ie, antibiotics that were prescribed within 30 days of another antibiotic prescription) ranged from 13.1% to 34.3%, with a mean of 23.2%. They also found that patients prescribed an antibiotic during the study period had a mean of 8.9 antibiotic prescriptions (SD=6.1) in the 3 years prior to the study, indicating that regular antibiotic use is common for a substantial group of patients. [Opening paragraph]