Better late or never

Resistance to second- and third-line antibiotics is predicted to increase by 70% by 2030 if effective public health measures are not employed (Organisation for Economic Cooperation and Development (OECD), 2018). The pandemic has further reinforced what a virus can do when we don't have the know-how or tools to protect ourselves, and the results could be similar for a wave of everyday microbial infections if we cannot tackle the looming crisis of antimicrobial resistance.

Antimicrobials continue to be overprescribed across the UK and on a global scale, which has a huge potential impact on the burden to come when resistance to such treatments is at an all-time high. Reducing unnecessary and inappropriate use of antibiotics where possible, particularly so in primary care where antibiotics are most prescribed, could be a way forward.

A few years back, the National Institute for Health and Care Excellence (NICE) (2016) released a quality statement declaring that prescribers in primary care could use delayed prescribing of antimicrobials where they were uncertain about whether a condition is self-limiting or likely to deteriorate. The rationale was that when there is clinical uncertainty, delayed prescribing offers health professionals an alternative to the immediate prescription of antibiotics, which may do more harm than good if the patient becomes resistant following several more prescriptions in similar circumstances (as may occur in people with chronic conditions in the community who are older, frail or living with a disability, and experiencing frequent symptoms of possible infection).