Antimicrobial resistance is a global health priority. Acute respiratory tract infections are common conditions prompting antibiotic prescription in primary care. GP registrars are an important group for antibiotic stewardship. Our previous intervention reduced GP registrars’ acute bronchitis antibiotic prescribing by 16%.
We aimed to test the efficacy of an updated, wholly online, registrar-supervisor intervention on registrars’ antibiotic prescribing rates.
This study was a non-randomized trial with non-equivalent control group design nested within the ReCEnT cohort study. Webinars, online educational modules, materials for practices and registrar-supervisor in-practice educational sessions comprised the intervention.
Of the 4612 acute bronchitis diagnoses recorded, 70% were prescribed antibiotics. There was a 7% absolute reduction in prescribing. This, however, was statistically non-significant (p=0.22).
The smaller effect size (relative to previous findings) and statistical non-significance raises questions regarding the scalability of this educational innovation in the expanded national RACGP training program. Alternative education delivery modalities should be considered – possibly including a small group face-to-face component.
Australia is among the top 25% of countries with the highest rates of antibiotic prescribed in the community. Many of these common infections such as upper respiratory tract infections may not warrant antibiotics, resulting with inappropriate antibiotic prescribing and use, contributing directly to antibiotic resistance. Providing decision support tools in the form of patient information sheets assist patients with their self-management of self-limiting common infections and encourage communication between patients and their healthcare providers.
During 2019-2020, seven patient information resources were developed with primary care providers and consumers using a co-design methodology. This study described the pilot implementation of the information resources to evaluate the usability and acceptability from the perspective of primary care providers and patients.
The resources were found to be easy to use and provided discussion points around patients’ infective illness during consultations. The content was thought to be relevant and increased patients’ knowledge of disease conditions, treatment options and when to seek medical advice. They are publicly available for use across Australia.
Antibiotic stewardship in Australian primary care requires practical, sustained strategies rather than short-term efforts. This review identifies delayed prescribing as the most effective consultation-based approach, reducing antibiotic use by 64% while maintaining patient safety and improving communication during consultations. Audit and feedback interventions, such as peer-comparison letters to high prescribers, achieved an additional 8–9% reduction across general practice but remain underused, with only a small proportion of GPs routinely engaging in such programs. These findings highlight the need for broader implementation and long-term investment in strategies that have proven to reduce prescribing in real-world settings. Strengthening national coordination, education, and feedback systems will help embed evidence-based stewardship approaches into daily practice, achieving sustained reductions in unnecessary antibiotic use and preserving antibiotic effectiveness for future generations.
Antibiotic resistance is a growing global threat, and general practice remains its front line – where most antibiotics are prescribed, often unnecessarily. In Australia, prescribing rates for acute respiratory infections are four to nine times higher than guideline recommendations, despite minimal clinical benefit in most cases. A key message from this article is that antibiotics are not the “safe default”; they can cause harm, reinforce unnecessary expectations, and undermine self-management for self-limiting infections. This study emphasises that communication, reassurance, and safety-netting are central to reducing overprescribing, as many GPs overestimate patient expectations for antibiotics. Yet uptake of these evidence-based approaches remains inconsistent, often constrained by diagnostic uncertainty, time pressure, and entrenched practice culture. Strengthening communication skills, normalising symptomatic care, and embedding practice-wide AMS messaging can produce sustained reductions in unnecessary antibiotic use and foster more confident, evidence-based prescribing across Australian primary care. Read more