Prescribe Wisely: Adhere to recommended antimicrobial course durations

Antibiotic Guardianship Awards. Shared Learning 2025 - Innovation and Technology

Project Overview

Unnecessarily long courses of antimicrobials contribute to antimicrobial resistance (AMR). While the All Wales Medicines Strategy Group (AWMSG) Primary Care Antimicrobial Guidelines recommend prescribing the shortest effective antibiotic courses for acute respiratory tract infections (RTIs), data from Welsh primary care shows considerable variation across healthboards.

Swansea Bay University Healthboard (SBUHB) Medicines Management Team utilised prescribing decision support software (ScriptSwitch) to highlight key prescribing messages and suggested quantity switches at the point of prescribing in GP practices. Simple messages were written and deployed to trigger when prescribing specific antibacterials, aiming to reduce the quantity supplied. Data collected on the acceptance rates of the suggested switches showed a positive outcome, with an acceptance rate exceeding 20%.

Building on the success of SBUHB’s ScriptSwitch messages, the All Wales Therapeutics and Toxicology Centre (AWTTC) collaborated with Public Health Wales (PHW) and Welsh Antimicrobial Pharmacy Group to ensure key antimicrobial prescribing messages and suggested quantity switches were visible to primary care prescribers across Wales. This national initiative resulted in the development of prescribing messages for course durations of amoxicillin, doxycycline, clarithromycin, and phenoxymethylpenicillin for the treatment of uncomplicated RTIs. The messages do not add additional workload to practices and are triggered when antimicrobials are prescribed for durations longer than 5-days, recommending a reduction to 5-days. From July 2024, the prescribing messages and suggested quantity switches were published in the AWTTC ScriptSwitch library for healthboards to use. The “Once for Wales” approach ensures consistent, evidence-based messages, eliminating duplication of effort by healthboards and allowing them to import and deploy antimicrobial course duration messages to local GP practices.

Overall, from August to November 2024, 23.25% of 11,910 prescription items across all four antibacterials were switched to a 5-day course duration. This project safely reduced patient exposure to antimicrobials and helped combat AMR by promoting the shortest-effective course.