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In turn, the primary care system experienced massive setbacks from the pandemic, with significant reductions in visit volume as patients stopped seeking in-person care, important organizational challenges with more phone consultations and many countries adopted digital-first strategies, remote monitoring and telehealth platforms to enable healthcare provision without physical interactions [1]. [3] found that the threshold for prescribing antibiotics for respiratory tract infections among English primary care doctors decreased during the first few months of the pandemic, caused by the change to remote consultations and the high uncertainty about the role of antibiotics for this infection that was present at the beginning of the pandemic, resembling the high usage of antibiotics given in the hospital setting for treating community-acquired pneumonia. [...]with the use of a large Catalonian primary care database which included all the suspected and confirmed COVID-19 infections during the first four months of the pandemic, a composite severity endpoint, comprising pneumonia, hospital admission and death due to COVID-19, was found to be more frequent among individuals who has previously consumed antibiotics compared to those who did not.

In this randomized trial, C-reactive protein testing was used as a point-of-care aid in determining whether antibiotic therapy was warranted in patients with an acute exacerbation of COPD. Among 653 outpatients, there was significantly less use of antibiotics with CRP guidance, with no evidence of any worse outcome.

BackgroundRespiratory tract infection tests are increasingly available in primary care and are expected to expand in the future. However, there is limited understanding of clinicians’ views on their benefits and how to effectively integrate them into daily clinical practice.ObjectivesThe aim of this study was to explore healthcare professionals’ views on using respiratory tract infection tests to safely reduce unnecessary antibiotic prescriptions for respiratory tract infections in primary care based on their experience in routine practice.DesignA qualitative study design was employed. Two focus group discussions were conducted.Setting and participantsThese focus group discussions were conducted in February 2025, involving 18 Spanish primary care professionals, both experts and non-experts in rational antibiotic use and antimicrobial resistance. Data were audio-recorded or video-recorded, transcribed and analysed thematically.ResultsParticipants agreed that respiratory tract infection tests help optimise antibiotic prescriptions, reduce uncertainty, ensure the appropriate consumption of resources and guide treatment based on aetiology. While most professionals view microbiological tests and C-reactive protein testing as complementary, non-experts preferred microbiological tests. Professionals considered that patients value knowing the aetiology over the prognosis, supporting shared decision-making and addressing patients’ demands more effectively. Concerns remain about using these tests as stand-alone tools and the medicalisation of self-limiting conditions. Other barriers mentioned included the high cost and time-consuming nature, the need for better professional training and the challenge of managing the increased workload associated with their use.ConclusionsThis study highlights how clinicians perceive respiratory tract infection tests to aid prescribing decisions amid uncertainty. Both positive and negative views were reported. Participants agreed that these tests optimise antibiotic prescriptions and guide treatment, but there are still important barriers to their implementation.

Antimicrobial resistance (AMR) continues to be a global problem and continues to be addressed through national strategies to improve diagnostics, develop new antimicrobials and promote antimicrobial stewardship. Patients who attend general (ambulatory) practice with symptoms of respiratory tract infections (RTIs) are invariably assessed by some sort of clinical decision rule (CDR). However, CDRs rely on a cluster of non-specific clinical observations. A narrative review of the literature was undertaken to ascertain the value of C reactive protein (CRP) point-of-care testing (POCT) to guide antibacterial prescribing in adult patients presenting to general practitioner (GP) practices with symptoms of RTI. Studies that were included were Cochrane reviews, systematic reviews, randomised controlled trials, cluster randomised trials, controlled before and after studies, cohort studies and economic evaluations. An overwhelming number of studies demonstrated that the use of CRP tests in patients presenting with RTI symptoms reduces index antibacterial prescribing. GPs and patients report a good acceptability for a CRP POCT and economic evaluations show cost-effectiveness of CRP POCT over existing RTI management in primary care. POCTs increase diagnostic precision for GPs in the better management of patients with RTI. With the rapid development of artificial intelligence, patients will expect greater precision in diagnosing and managing their illnesses. Adopting systems that markedly reduce antibiotic consumption is a no-brainer for governments that are struggling to address the rise in AMR.

High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems. After a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214. The baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42–0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54–0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36–0·74, p<0·0001; enhanced communication 0·68, 0·50–0·89, p=0·003; combined 0·38, 0·25–0·55, p<0·0001). Internet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries. European Commission Framework Programme 6, National Institute for Health Research, Research Foundation Flanders.

BackgroundWomen with recurrent urinary tract infections (UTIs) often undergo intensive antibiotic exposure, especially with suppressive therapies. Suppressive therapy is recommended for women with three UTIs in the past year or two in the last 6 months. However, the collateral long-term effects of this have been poorly studied.ObjectivesTo assess whether suppressive therapy for recurrent UTIs increases the incidence and severity of future infections compared with episodic UTI treatment.Design Retrospective cohort study.Setting and ParticipantsThe study was conducted using data from the Information System for Research in Primary Care database, including 5.8 million people in Catalonia. Two groups of women with recurrent UTIs (≥3 episodes/year) were compared: those on suppressive antibiotic therapy for ≥6 months and those treated episodically. Primary outcomes were hospitalisations due to pyelonephritis, septicaemia, COVID-19, influenza, pneumonia and mortality by these infections, over a 100-month follow-up period.ResultsAmong 36 170 women, 2898 (8%) were treated with continuous suppressive therapy. Overall, 6.9% of the population experienced severe infections, with a higher incidence in women on suppressive therapy (12.6%) compared with those without (6.4%), with a HR of 1.50 (95% CI 1.33 to 1.68). Pyelonephritis presented the greatest difference (HR, 1.95 (95% CI 1.64 to 2.33)), followed by septicaemia (HR, 1.34 (95% CI 1.13 to 1.59)) and COVID-19 (HR 1.23 (95% CI 1.01 to 1.50)).ConclusionsSuppressive antibiotic therapy in women with recurrent UTIs is associated with a higher incidence and severity of future infections. Future research should focus on clarifying causal relationships and identifying the potential mechanisms involved.