Antibiotics Prescribed Responsibly by UK Doctors

Antibiotics treat bacterial infections and have no effect on viral illnesses such as the common cold, influenza, or most sore throats.

Distinguishing bacterial from viral infection is a core clinical skill, and responsible prescribing starts with this differentiation.

Common bacterial infections that genuinely require antibiotic treatment include:

• Urinary tract infections (dysuria, frequency, suprapubic pain with positive dipstick showing nitrites and leucocytes)
• Bacterial skin infections (cellulitis, impetigo, infected wounds with spreading erythema)
• Lower respiratory tract infections with clinical signs of bacterial pneumonia (productive cough, fever above 38.5°C, focal chest signs)
• Sexually transmitted infections such as chlamydia (azithromycin 1 g single dose or doxycycline 100 mg twice daily for 7 days)
• Acute bacterial sinusitis persisting beyond 10 days with purulent discharge

However, many infections presented in primary care are self-limiting.

A study published in the BMJ found that 72% of sore throats resolve within 7 days without antibiotics, and NICE recommends delayed prescriptions or no antibiotics for most cases of acute bronchitis, otitis media in children over 2, and mild sinusitis.

CRP point-of-care testing helps guide prescribing decisions. A CRP below 20 mg/L suggests viral aetiology where antibiotics can be safely withheld.

Values between 20-100 mg/L warrant clinical judgement, while CRP above 100 mg/L strongly suggests bacterial infection requiring treatment.

The decision to prescribe involves weighing the severity of infection, patient risk factors (immunosuppression, extremes of age, comorbidities), and the probability of bacterial versus viral aetiology.

This clinical assessment is conducted for every consultation at Dr. Presc.

UK prescribers follow the NICE Clinical Knowledge Summaries and local antimicrobial formularies when selecting antibiotics.

The principle of using the narrowest-spectrum effective agent at the lowest effective dose for the shortest appropriate duration guides every decision.

Amoxicillin remains the most prescribed antibiotic in UK primary care.

A penicillin-class drug, it is first-line for chest infections, ear infections, dental abscesses, and urinary tract infections where sensitivity is confirmed.

Standard dosing is 500 mg three times daily for 5-7 days.

For penicillin-allergic patients, clarithromycin 500 mg twice daily or doxycycline 200 mg on day one followed by 100 mg daily are typical alternatives.

Nitrofurantoin 100 mg modified-release twice daily for 3 days is the NICE-recommended first-line treatment for uncomplicated lower UTIs in women, owing to low resistance rates (approximately 3% in the UK) and minimal impact on gut flora.

Doxycycline is a tetracycline antibiotic with broad activity against atypical pathogens, making it first-line for community-acquired pneumonia when atypical infection is suspected, and the treatment of choice for chlamydia (100 mg twice daily for 7 days).

It is also used for rosacea, acne, and Lyme disease.

Flucloxacillin 500 mg four times daily for 5-7 days treats staphylococcal and streptococcal skin infections including cellulitis and wound infections.

It must be taken on an empty stomach (30 minutes before food).

Co-amoxiclav (amoxicillin plus clavulanic acid) is reserved for infections where beta-lactamase-producing organisms are suspected, such as UTIs failing first-line treatment, complicated skin infections, and animal bite wounds.

Key prescribing considerations:

• Renal dose adjustment required for nitrofurantoin (avoid if eGFR below 45)
• Metronidazole interacts with alcohol (disulfiram-like reaction)
• Macrolides (clarithromycin, azithromycin) prolong the QT interval
• Doxycycline causes photosensitivity and oesophageal irritation if taken without adequate fluid

Antimicrobial resistance (AMR) represents a public health emergency. In the UK, drug-resistant infections already cause an estimated 12,000 deaths annually.

The government's 5-year AMR national action plan sets ambitious targets to reduce antibiotic use in humans by 15% by 2025 and to halve the number of drug-resistant infections by 2030.

Resistance mechanisms develop through natural bacterial evolution accelerated by antibiotic overuse. Bacteria acquire resistance genes through mutations or horizontal gene transfer via plasmids.

• E. coli resistance to amoxicillin: 55-60%
• E. coli resistance to trimethoprim: 35-40%
• MRSA prevalence in community infections: approximately 1.5%
• Extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae: rising year on year

The consequences of resistance are severe. Infections that were once easily treatable become prolonged, complicated, and potentially fatal.

Resistant infections require second-line or intravenous antibiotics with greater toxicity and cost.

Routine surgical procedures, chemotherapy, and organ transplantation all depend on effective prophylactic antibiotics.

How patients can help:

• Never request antibiotics for viral infections (colds, flu, most sore throats)
• Complete the prescribed course as directed — stopping early exposes bacteria to sub-therapeutic levels that promote resistance
• Never share antibiotics or use leftover medication from previous prescriptions
• Practise good hand hygiene and food safety to prevent infection transmission
• Keep vaccinations up to date, reducing the need for antibiotics in the first place

At Dr. Presc, antibiotic stewardship is embedded in the prescribing protocol.

Every request is clinically assessed, and antibiotics are declined when the presentation is more consistent with a viral illness.

Delayed prescriptions are offered where appropriate, allowing the patient to fill the prescription only if symptoms worsen after 48-72 hours.

Public Health England monitors prescribing data and resistance patterns nationally, publishing the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report annually.

Maximising the effectiveness of antibiotic treatment while minimising side effects requires attention to dosing, timing, and potential interactions.

As a prescriber, I always ensure patients understand how to take their medication correctly.

Timing and food interactions vary between antibiotics:

• Flucloxacillin and phenoxymethylpenicillin: take on an empty stomach, 30-60 minutes before food
• Amoxicillin and co-amoxiclav: can be taken with or without food; taking with food reduces GI upset
• Doxycycline: take with food and a full glass of water; remain upright for 30 minutes to prevent oesophageal ulceration
• Nitrofurantoin: take with food to improve absorption and reduce nausea

Common side effects affect approximately 10-20% of patients and include:

• Gastrointestinal disturbance (nausea, diarrhoea, abdominal pain) — probiotics may reduce antibiotic-associated diarrhoea by 40% according to Cochrane review data
• Vaginal thrush from disruption of normal flora — particularly common with broad-spectrum agents
• Skin rash (non-allergic maculopapular rash occurs in 5-10% of amoxicillin courses)
• Photosensitivity with doxycycline and fluoroquinolones

Serious reactions to watch for:

• Anaphylaxis (penicillin allergy affects 1-2% of the population; true IgE-mediated allergy is much rarer at 0.01-0.05%)
• Clostridium difficile infection: prolonged, severe diarrhoea, particularly in older adults or those recently hospitalised
• Stevens-Johnson syndrome: extremely rare but requires immediate medical attention if widespread skin blistering develops
• Tendon rupture with fluoroquinolones: MHRA issued a safety alert restricting their use

Drug interactions to discuss with your prescriber:

• Clarithromycin and statins: increased risk of myopathy and rhabdomyolysis
• Metronidazole and alcohol: severe nausea and flushing (avoid for 48 hours after completing course)
• Rifampicin and oral contraceptives: reduced contraceptive efficacy
• Tetracyclines and dairy/antacids: reduced absorption due to chelation with calcium, iron, and magnesium

Report any worsening symptoms, new symptoms, or failure to improve after 48-72 hours to your prescriber.

Antibiotic failure may indicate a resistant organism requiring culture sensitivity testing and treatment adjustment.

Prescribing antibiotics through an online consultation requires the same clinical rigour as a face-to-face appointment. At Dr.

Presc, the process follows NICE antimicrobial prescribing guidelines and the Royal Pharmaceutical Society's standards for digital prescribing.

The consultation begins with a structured questionnaire that captures:

• Presenting symptoms, duration, and severity
• Previous antibiotic use for the same condition
• Allergy history (with specific questioning about penicillin reactions to distinguish true allergy from non-allergic side effects)
• Current medications (to screen for interactions)
• Relevant medical history (renal impairment, liver disease, immunosuppression, pregnancy)

A UK-registered prescriber reviews each submission individually, assessing whether the presentation is consistent with a bacterial infection warranting antibiotic treatment.

• Symptoms consistent with viral upper respiratory tract infections
• Uncomplicated sore throats scoring below 3 on the FeverPAIN or Centor criteria
• Self-limiting conditions where watchful waiting or symptomatic relief is more appropriate
• Vague or insufficient symptom descriptions where a physical examination would be needed

When antibiotic prescribing is appropriate, the narrowest-spectrum agent is selected. The prescription specifies the exact dose, frequency, duration, and any food or interaction precautions.

Dispensing is through GPhC-registered pharmacies with next-day delivery available.

Follow-up care is built into the process.

Patients are advised to return for reassessment if symptoms have not improved within 48-72 hours, if symptoms worsen at any point, or if new symptoms develop.

Where clinically indicated, the prescriber may recommend attending a GP surgery or walk-in centre for physical examination, blood tests, or specimen culture.

The platform maintains a full audit trail of every consultation and prescribing decision, ensuring accountability and facilitating continuity of care should the patient's regular GP need to review the treatment.