A National Data Driven Approach to Optimising Antibiotic Course Duration in Wales

All Wales Therapeutics and Toxicology Centre (AWTTC)

Project summary

Unnecessary antibiotic exposure increases the risk of adverse effects, antimicrobial resistance (AMR) and contributes to environmental impact of medicines and their carbon footprint. The All-Wales Medicines Strategy Group (AWMSG) Primary Care antimicrobial guidelines recommend the shortest effective course for uncomplicated respiratory tract infections (RTIs). However, prescribing data showed variation across health boards with many prescriptions exceeding the recommended 5-day course.

To address this, antibiotic course duration for RTIs was prioritised during development of the 2025–2028 national prescribing indicator (NPI) set for NHS Wales, which began in autumn 2023 using a stakeholder-led approach. Although formally introduced in April 2025, health boards were aware of the proposed indicator during development. The target was for 75% of all 5- and 7-day prescriptions for amoxicillin 500mg capsules, doxycycline 100mg capsules and clarithromycin 500mg tablets to be issued as 5-day courses.

Implementation was supported by a national interactive digital dashboard developed by Steven Griffiths, data analyst at the All-Wales Therapeutics and Toxicology Centre (AWTTC). The dashboard presents prescribing data at health board, cluster and GP practice level, allowing users to compare performance against the 75% target and between health boards and GP practices. Antimicrobial pharmacy teams use the dashboard to identify variation and target local interventions. National course duration messages and quantity switches were also developed with Public Health Wales (PHW) and the Welsh Antimicrobial Pharmacy Group (WAPG) using prescribing decision support systems to encourage selection of 5-day courses at the point of prescribing.

Progress is monitored through quarterly NPI reports using data from the new dashboard. Between September 2023 and December 2025, 5-day prescriptions increased as a percentage of all 5- and 7-day prescriptions for each antibiotic: from 50.0% to 85.1% for amoxicillin 500mg capsules, from 27.0% to 72.4% for doxycycline 100mg capsules, and from 26.0% to 61.2% for clarithromycin 500mg tablets. Variation across the seven health boards reduced over the same period. Each switch from a 7- to 5-day course avoids two days of antibiotic exposure, reducing unnecessary medicine use, waste and carbon emissions. Shorter antibiotic courses may also improve patient outcomes by reducing risk of adverse reactions, improving adherence and lowering AMR risk.

Based on reduced quantities prescribed in 2025 compared with 2024, estimated savings were £86,000 for amoxicillin, £38,500 for doxycycline and £109,500 for clarithromycin, totalling £234,000. This project demonstrates that an antibiotic NPI supported by digital tools can drive measurable improvement in antimicrobial prescribing at scale, contributing to clinical, financial and environmental benefits.