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Original research
Risks of use and non-use of antibiotics in primary care: qualitative study of prescribers’ views
  1. Olga Boiko1,
  2. Caroline Burgess1,
  3. Robin Fox2,
  4. Mark Ashworth1,
  5. Martin C Gulliford1
  1. 1School of Population Health and Environmental Sciences, King's College London, London, UK
  2. 2Bicester Health Centre, Bicester, Oxfordshire, UK
  1. Correspondence to Dr Martin C Gulliford; martin.gulliford{at}


Purpose The emergence of antimicrobial resistance has led to increasing efforts to reduce unnecessary use of antibiotics in primary care, but potential hazards from bacterial infection continue to cause concern. This study investigated how primary care prescribers perceive risk and safety concerns associated with reduced antibiotic prescribing.

Methods Qualitative study using semistructured interviews conducted with primary care prescribers from 10 general practices in an urban area and a shire town in England. A thematic analysis was conducted.

Results Thirty participants were recruited, including twenty-three general practitioners, five nurses and two pharmacists. Three main themes were identified: risk assessment, balancing treatment risks and negotiating decisions and risks. Respondents indicated that their decisions were grounded in clinical risk assessment, but this was informed by different approaches to antibiotic use, with most leaning towards reduced prescribing. Prescribers’ perceptions of risk included the consequences of both inappropriate prescribing and inappropriate withholding of antibiotics. Sepsis was viewed as the most concerning potential outcome of non-prescribing, leading to possible patient harm and potential litigation. Risks of antibiotic prescribing included antibiotic resistant and Clostridium difficile infections, as well as side effects, such as rashes, that might lead to possible mislabelling as antibiotic allergy. Prescribers elicited patient preferences for use or avoidance of antibiotics to inform management strategies, which included educational advice, advice on self-management including warning signs, use of delayed prescriptions and safety netting.

Conclusions Attitudes towards antibiotic prescribing are evolving, with reduced antibiotic prescribing now being approached more systematically. The safety trade-offs associated with either use or non-use of antibiotics present difficulties especially when prescribing decisions are inconsistent with patients’ expectations.

  • primary care
  • infectious diseases
  • health & safety
  • health policy

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Contributors OB and MCG designed the study. CB advised on the development of the interview guide. MA and RF advised on the recruitment strategy and facilitated its implementation. OB conducted the analysis with support from CB. OB drafted the paper. All authors commented on and approved the paper.

  • Funding The study was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Programme (16/116/46). MCG was supported by the NIHR Biomedical Research Centre at Guy’s and St Thomas’ Hospitals. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. The funder of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. The authors had full access to all the data in the study and all authors shared final responsibility for the decision to submit for publication.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data that support the findings of this study are available from the corresponding author upon reasonable request.

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