POTENTIAL STRATEGIES AND APPROACHES TO REDUCE THE INAPPROPRIATE USE OF ANTIBIOTICS IN THE MANAGEMENT OF RESPIRATORY TRACT INFECTIONS IN PRIMARY CARE
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6299Keywords:
Respiratory Tract Infections, Primary Care, Antibiotic Resistance, Antibiotic Overuse, StrategiesAbstract
Introduction and Purpose: The application of antibiotics has enabled the effective treatment of bacterial infections for years. However, their inappropriate use and overprescribing remain longstanding concerns. A considerable proportion of antibiotic prescriptions originate in primary care, where respiratory tract infections constitute one of the most common indications. The aim of this study was to investigate potential strategies to reduce inappropriate antibiotic use in the management of respiratory tract infections in the primary care setting.
Materials and Methods: The methodology was based on a review of the available literature using the PubMed and Google Scholar databases. The following keywords were applied: “primary care”, “respiratory tract infection”, “limiting antibiotic overuse”, and “strategies”.
Description of the state of knowledge: The findings indicate that a range of methods and interventions may contribute to reducing antibiotic overuse in primary care. These include educational and behavioral interventions targeting both patients and healthcare professionals, as well as efforts to reduce diagnostic uncertainty, for example through the use of point-of-care biomarkers. Additional approaches such as delayed antibiotic prescribing, the implementation of non-antibiotic treatment strategies, and preventive measures aimed at reducing the incidence of respiratory tract infections may also play an important role. The analyzed methods were evaluated not only in terms of their effectiveness but also with regard to their limitations and the requirements necessary for their implementation.
Conclusions: Overall, the review underscores the need for further research to better define and optimize strategies for reducing inappropriate antibiotic use and limit the development of antimicrobial resistance.
References
Gulliford, M. C., Juszczyk, D., Prevost, A. T., et al. (2019). Electronically delivered interventions to reduce antibiotic prescribing for respiratory infections in primary care: Cluster RCT using electronic health records and cohort study. Health Technology Assessment, 23, 1–72. https://doi.org/10.3310/hta23110
Okubo, Y., Uda, K., & Miyairi, I. (2025). Long-term effectiveness of financial incentives for not prescribing unnecessary antibiotics to children with acute respiratory and gastrointestinal infections: Japan’s nationwide quasi-experimental study. Clinical Infectious Diseases, 81, 602–609. https://doi.org/10.1093/cid/ciae577
Muraki, Y., Kusama, Y., Tanabe, M., et al. (2020). Impact of antimicrobial stewardship fee on prescribing for Japanese pediatric patients with upper respiratory infections. BMC Health Services Research, 20. https://doi.org/10.1186/s12913-020-05288-1
Baan, E. J., Janssens, H. M., Kerckaert, T., et al. (2018). Antibiotic use in children with asthma: Cohort study in UK and Dutch primary care databases. BMJ Open, 8. https://doi.org/10.1136/bmjopen-2018-022979
Tyrstrup, M., Beckman, A., Mölstad, S., et al. (2016). Reduction in antibiotic prescribing for respiratory tract infections in Swedish primary care—A retrospective study of electronic patient records. BMC Infectious Diseases, 16. https://doi.org/10.1186/s12879-016-2018-9
Saliba-Gustafsson, E. A., Nyberg, A., Borg, M. A., et al. (2021). Barriers and facilitators to prudent antibiotic prescribing for acute respiratory tract infections: A qualitative study with general practitioners in Malta. PLOS ONE, 16. https://doi.org/10.1371/journal.pone.0246782
O’Connor, R., O’Doherty, J., O’Regan, A., et al. (2018). Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review. Irish Journal of Medical Science, 187, 969–986. https://doi.org/10.1007/s11845-018-1774-5
Dekker, A. R. J., Verheij, T. J. M., Broekhuizen, B. D. L., et al. (2018). Effectiveness of general practitioner online training and an information booklet for parents on antibiotic prescribing for children with respiratory tract infection in primary care: A cluster randomized controlled trial. Journal of Antimicrobial Chemotherapy, 73, 1416–1422. https://doi.org/10.1093/jac/dkx542
McNicholas, M., & Hooper, G. (2022). Effects of patient education to reduce antibiotic prescribing rates for upper respiratory infections in primary care. Family Practice, 39, 1–5. https://doi.org/10.1093/fampra/cmab054
McIsaac, W., Kukan, S., Huszti, E., et al. (2021). A pragmatic randomized trial of a primary care antimicrobial stewardship intervention in Ontario, Canada. BMC Family Practice, 22. https://doi.org/10.1186/s12875-021-01536-3
Chiswell, E., Hampton, D., & Okoli, C. T. C. (2019). Effect of patient and provider education on antibiotic overuse for respiratory tract infections. Journal for Healthcare Quality, 41, E13–E20. https://doi.org/10.1097/JHQ.0000000000000144
Fallatah, M. S., Alzahrani, A. A., Alghamdi, G. S., et al. (2023). Patient beliefs on antibiotic prescribing in primary care: A cross-sectional survey in Saudi Arabia. Cureus. https://doi.org/10.7759/cureus.38254
Godman, B., Haque, M., McKimm, J., et al. (2020). Strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: Findings and implications.
Elizondo-Alzola, U., Rocha, C., Leache, L., et al. (2025). Educational interventions and contextual factors for optimising antibiotic prescription in paediatric uncomplicated acute respiratory tract infections in primary care: Scoping review of reviews. BMC Pediatrics, 25. https://doi.org/10.1186/s12887-025-05688-4
Cabral, C., Lucas, P. J., Ingram, J., et al. (2015). “It’s safer to ...” Parent consulting and clinician antibiotic prescribing decisions for children with respiratory tract infections: An analysis across four qualitative studies. Social Science & Medicine, 136–137, 156–164. https://doi.org/10.1016/j.socscimed.2015.05.027
Boaitey, K. P., Bakhit, M., & Hoffmann, T. C. (2024). Mapping the evidence about the natural history of acute infections commonly seen in primary care and managed with antibiotics: A scoping review. BMC Infectious Diseases, 24. https://doi.org/10.1186/s12879-024-09526-3
McCleary, N., Francis, J. J., Campbell, M. K., et al. (2021). Antibiotic prescribing for respiratory tract infection: Exploring drivers of cognitive effort and factors associated with inappropriate prescribing. Family Practice, 38, 740–750. https://doi.org/10.1093/fampra/cmab030
Strumann, C., Steinhaeuser, J., Emcke, T., et al. (2020). Communication training and the prescribing pattern of antibiotic prescription in primary health care. PLOS ONE, 15. https://doi.org/10.1371/journal.pone.0233345
Biezen, R., Brijnath, B., Grando, D., et al. (2017). Management of respiratory tract infections in young children—A qualitative study of primary care providers’ perspectives. NPJ Primary Care Respiratory Medicine, 27. https://doi.org/10.1038/s41533-017-0018-x
O’Connor, R., O’Doherty, J., O’Regan, A., et al. (2019). Medical management of acute upper respiratory infections in an urban primary care out-of-hours facility: Cross-sectional study of patient presentations and expectations. BMJ Open, 9. https://doi.org/10.1136/bmjopen-2018-025396
Mortazhejri, S., Mortazhejri, S., Patey, A. M., et al. (2020). Understanding determinants of patients’ decisions to attend their family physician and to take antibiotics for upper respiratory tract infections: A qualitative descriptive study. BMC Family Practice, 21. https://doi.org/10.1186/s12875-020-01196-9
Van Esch, T. E. M., Brabers, A. E. M., Hek, K., et al. (2018). Does shared decision-making reduce antibiotic prescribing in primary care? Journal of Antimicrobial Chemotherapy, 73, 3199–3205. https://doi.org/10.1093/jac/dky321
Brookes-Howell, L., Wood, F., Verheij, T., et al. (2014). Trust, openness and continuity of care influence acceptance of antibiotics for children with respiratory tract infections: A four country qualitative study. Family Practice, 31, 102–110. https://doi.org/10.1093/fampra/cmt052
Kronman, M. P., Gerber, J. S., Grundmeier, R. W., et al. (2020). Reducing antibiotic prescribing in primary care for respiratory illness. Pediatrics, 146. https://doi.org/10.1542/PEDS.2020-0038
Harrigan, J. J., Hamilton, K. W., Cressman, L., et al. (2024). Antibiotic prescribing patterns for respiratory tract illnesses following the conclusion of an education and feedback intervention in primary care. Clinical Infectious Diseases, 78, 1120–1127. https://doi.org/10.1093/cid/ciad754
Lane, I., Bryce, A., Ingle, S. M., et al. (2018). Does locally relevant, real-time infection epidemiological data improve clinician management and antimicrobial prescribing in primary care? A systematic review. Family Practice, 35, 542–550. https://doi.org/10.1093/fampra/cmy008
Wang, D., Liu, C., Zhang, X., et al. (2021). Does diagnostic uncertainty increase antibiotic prescribing in primary care? NPJ Primary Care Respiratory Medicine, 31. https://doi.org/10.1038/s41533-021-00229-9
Hackert, V. H., Dukers-Muijrers, N. H. T. M., & Hoebe, C. J. P. A. (2020). Signs and symptoms do not predict, but may help rule out acute Q fever in favour of other respiratory tract infections, and reduce antibiotics overuse in primary care. BMC Infectious Diseases, 20. https://doi.org/10.1186/s12879-020-05400-0
Hay, A. D., Redmond, N. M., Turnbull, S., et al. (2016). Development and internal validation of a clinical rule to improve antibiotic use in children presenting to primary care with acute respiratory tract infection and cough: A prognostic cohort study. The Lancet Respiratory Medicine, 4, 902–910. https://doi.org/10.1016/S2213-2600(16)30223-5
Clarke, R., Brown, E., Hay, A. D., et al. (2025). Rapid microbiological respiratory point-of-care testing: A qualitative study with primary care clinicians. British Journal of General Practice, 75, e241–e249. https://doi.org/10.3399/BJGP.2024.0413
Do, N. T. T., Vu, T. V. D., Greer, R. C., et al. (2023). Implementation of point-of-care testing of C-reactive protein concentrations to improve antibiotic targeting in respiratory illness in Vietnamese primary care: A pragmatic cluster-randomised controlled trial. The Lancet Infectious Diseases, 23, 1085–1094. https://doi.org/10.1016/S1473-3099(23)00125-1
Llor, C. (2025). C-reactive protein point-of-care testing to guide antibiotic prescribing for respiratory tract infections. Expert Review of Respiratory Medicine, 19, 863–877. https://doi.org/10.1080/17476348.2025.2510378
Smedemark, S. A., Llor, C., Aabenhus, R., et al. (2022). Biomarkers as point-of-care tests to guide prescription of antibiotics in people with acute respiratory infections in primary care. Cochrane Database of Systematic Reviews, 2022. https://doi.org/10.1002/14651858.CD010130.pub3
Gentile, I., Schiano Moriello, N., Hopstaken, R., et al. (2023). The role of CRP POC testing in the fight against antibiotic overuse in European primary care: Recommendations from a European expert panel. Diagnostics, 13. https://doi.org/10.3390/diagnostics13020320
Cooke, J., Llor, C., Hopstaken, R., et al. (2020). Respiratory tract infections (RTIs) in primary care: Narrative review of C reactive protein (CRP) point-of-care testing (POCT) and antibacterial use in patients who present with symptoms of RTI. BMJ Open Respiratory Research, 7. https://doi.org/10.1136/bmjresp-2020-000624
Lhopitallier, L., Kronenberg, A., Meuwly, J. Y., et al. (2021). Procalcitonin and lung ultrasonography point-of-care testing to determine antibiotic prescription in patients with lower respiratory tract infection in primary care: Pragmatic cluster randomised trial. BMJ, 374. https://doi.org/10.1136/bmj.n2132
Cohen, J. F., Tanz, R. R., & Shulman, S. T. (2024). Group A Streptococcus pharyngitis in children: New perspectives on rapid diagnostic testing and antimicrobial stewardship. Journal of the Pediatric Infectious Diseases Society, 13, 250–256. https://doi.org/10.1093/jpids/piae022
Wilcox, C. R., Odeh, N., Clark, T. W., et al. (2024). Use of the FebriDx® host-response point-of-care test may reduce antibiotic use for respiratory tract infections in primary care: A mixed-methods feasibility study. Journal of Antimicrobial Chemotherapy, 79, 1441–1449. https://doi.org/10.1093/jac/dkae127
Moragas, A., Cots, J. M., & Llor, C. (2025). Views of Spanish primary care professionals on respiratory tract infection testing: A qualitative study. BMJ Open, 15, e102476. https://doi.org/10.1136/bmjopen-2025-102476
Essack, S., & Pignatari, A. C. (2013). A framework for the non-antibiotic management of upper respiratory tract infections: Towards a global change in antibiotic resistance. International Journal of Clinical Practice, 67, 4–9. https://doi.org/10.1111/ijcp.12335
Little, P., Vennik, J., Rumsby, K., et al. (2024). Nasal sprays and behavioural interventions compared with usual care for acute respiratory illness in primary care: A randomised, controlled, open-label, parallel-group trial. The Lancet Respiratory Medicine, 12, 619–632. https://doi.org/10.1016/S2213-2600(24)00140-1
Zawadzka-Głos, L. (2023). Microbiota and antibiotic therapy in rhinosinusitis. Otolaryngologia Polska, 77, 37–43. https://doi.org/10.5604/01.3001.0053.8709
Liu, Y., Chen, Y., Liao, H., et al. (2025). Research progress on the application of Lacticaseibacillus rhamnosus GG in pediatric respiratory diseases. Frontiers in Nutrition, 12. https://doi.org/10.3389/fnut.2025.1553674
Derbyshire, E. J., & Calder, P. C. (2021). Respiratory tract infections and antibiotic resistance: A protective role for vitamin D? Frontiers in Nutrition, 8. https://doi.org/10.3389/fnut.2021.652469
Godman, B., Egwuenu, A., Haque, M., et al. (2021). Strategies to improve antimicrobial utilization with a special focus on developing countries. Life, 11. https://doi.org/10.3390/life11060528
Marengo, R., Ortega Martell, J. A., Esposito, S., et al. (2020). Paediatric recurrent ear, nose and throat infections and complications: Can we do more? https://doi.org/10.6084/m9.figshare.11671980
Andrews, T., Thompson, M., Buckley, D. I., et al. (2012). Interventions to influence consulting and antibiotic use for acute respiratory tract infections in children: A systematic review and meta-analysis. PLOS ONE, 7. https://doi.org/10.1371/journal.pone.0030334
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Copyright (c) 2026 Klaudia Gogól Fijał, Zuzanna Michalik, Klaudia Kapelka, Stanisław Malik, Przemysław Paduch, Zofia Bułka, Joanna Mazur, Dawid Kłos, Duszan Leja, Klaudia Czech, Kaja Zdrojewska, Lena Apanowicz, Patrycja Białowąs

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