Delayed prescribing of antibiotics for self-limiting respiratory tract infections in an urgent care out of hours setting

Long-term overuse of antibiotics and inappropriate prescribing has led to widespread development of antimicrobial resistance. The Department of Health
and Social Care recently published a five-year national action plan to reduce antimicrobial resistance, with the aim of reducing inappropriate antibiotic
prescribing. This is mirrored in the NHS Long Term Plan, which aims to reduce unintentional exposure through a combination of antibiotic stewardship and
leadership at all levels. An acute respiratory tract infection is one of the most common presentations in primary care, with 16.7% of all prescriptions issued
attributed to it. Therefore, out-of-hours prescribers contribute significantly to general antibiotic consumption. This article analyses the practice of delayed
prescribing of antibiotics for the treatment of self-limiting respiratory tract infections in an out-of-hours service. The advantages and disadvantages associated with delayed prescribing, to safely treat patients whilst facilitating the reduction of antimicrobial resistance, are discussed. In addition,
recommendations for future practice are offered. This article also focuses on the development of an advanced nurse practitioner, reflecting on the four
pillars of advanced practice, which underpin advanced clinical practice and associated competencies.