Assess urgent care (UC) clinician prescribing practices and factors associated with first-line antibiotic selection and recommended duration of therapy for sinusitis, acute otitis media (AOM), and pharyngitis.

Retrospective cohort study.

All respiratory UC encounters and clinicians in the Intermountain Health (IH) network, July 1st, 2019–June 30th, 2020.

Descriptive statistics were used to characterize first-line antibiotic selection rates and the duration of antibiotic prescriptions during pharyngitis, sinusitis, and AOM UC encounters. Patient and clinician characteristics were evaluated. System-specific guidelines recommended 5–10 days of penicillin, amoxicillin, or amoxicillin-clavulanate as first-line. Alternative therapies were recommended for penicillin allergy. Generalized estimating equation modeling was used to assess predictors of first-line antibiotic selection, prescription duration, and first-line antibiotic prescriptions for an appropriate duration.

Among encounters in which an antibiotic was prescribed, the rate of first-line antibiotic selection was 75%, the recommended duration was 70%, and the rate of first-line antibiotic selection for the recommended duration was 53%. AOM was associated with the highest rate of first-line prescriptions (83%); sinusitis the lowest (69%). Pharyngitis was associated with the highest rate of prescriptions for the recommended duration (91%); AOM the lowest (51%). Penicillin allergy was the strongest predictor of non–first-line selection (OR = 0.02, 95% CI [0.02, 0.02]) and was also associated with extended duration prescriptions (OR = 0.87 [0.80, 0.95]).

First-line antibiotic selection and duration for respiratory UC encounters varied by diagnosis and patient characteristics. These areas can serve as a focus for ongoing stewardship efforts.

This study aims to evaluate changes in the durations of English National Health Service prescriptions, as indicated by the volumes of unit doses supplied between 1998 and 2009, and consider relevant policy implications.

Around the world, countries are seeking to manage the increase in medicines prescribing. In England, many primary care organisations, using limited supporting evidence of cost-effectiveness and clinical improvement, have sought to restrict the number of dosage units on a prescription to 28 days supply. This is based on a conviction that this reduces wastage costs.

Prescription Cost Analysis (PCA) statistics for England for the period January 1998 to December 2009 were used to analyse trends in the average number of unit doses (tablets or capsules) supplied per prescription for 11 drugs supplied in 34 different presentations.

The changes in prescription lengths observed between 1999 and 2009 ranged from +4.2% in the case of Amoxicillin 500 mg capsules to −41.3% in the case of Levothyroxine 50 μg tablets. All but four of the medicines selected showed statistically significant negative correlations (r > 0.8, P < 0.001) between the year of prescribing and the prescription length. If prescription lengths had been the same in 2009 as they were in 1999, then 33 million fewer prescription items would have been written for the preparations in this analysis. This shift across a range of medications suggests a generalised change in prescribing behaviour. The full balance of benefits and costs associated with this trend, as expressed via drug wastage avoided, patient (in)convenience experienced, professional time costs incurred or saved and positive or negative health outcome impacts, is not known. Although this study does not provide a definitive answer favouring prescription duration individualisation as opposed to standardisation, the available evidence indicates that policies that rigidly favour 28-day standard periods may require review.