RTIs are one of the most common reasons people visit a GP in the UK. Many RTIs are caused by viruses and current primary care guidelines recommend a no or delayed antibiotic prescribing strategy in the vast majority of patients. Despite this, 54 per cent of RTI consultations in UK primary care result in an antibiotic prescription, and RTIs account for 60 per cent of antibiotic prescribing in primary care worldwide. As such, RTIs are one of the key drivers of antimicrobial resistance.

The study, which analysed over 900,000 RTI episodes in clinical records from across 530 English general practices, found that nearly 20 per cent of adults and 10 per cent of children received a second course of antibiotics within the same episode of a lower RTI (chest infection). Almost half (48.3 per cent) of these repeat prescriptions involved the same antibiotic class.

Previous research has shown that for most child and adult patients with chest infections, particularly those without chronic lung disease, even a single antibiotic course is unlikely to have clinical benefit, raising concerns about antibiotic overuse and resistance.^{1 2}

Factors associated with repeat prescriptions included frequent RTI-related GP visits and prior repeat within-episode RTI antibiotic prescriptions. Age was a significant determinant, with both young children (< 2 years) and older adults (65+) more likely to receive repeat prescriptions.

Arief Lalmohamed, Senior Lecturer at University Medical Center Utrecht and lead author of the study, said: "Repeat within-episode antibiotic use accounts for a significant proportion of all antibiotics prescribed for RTIs. In light of our findings, it's clear that antimicrobial stewardship interventions must extend beyond initial antibiotic prescriptions to address within-episode repeats."

Alastair Hay, a GP and Professor of Primary Care at the Centre for Academic Primary Care, University of Bristol, and Principal Investigator on the study, added: "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 NICE recommends five-day antibiotic courses for the severest lower respiratory tract infections, such as pneumonia."

Paper

'Within-episode repeat antibiotic prescriptions in patients with respiratory tract infections: A population-based cohort study' Arief Lalmohamed et al. in the Journal of Infection [open access]