Although antibiotics are thought to have a role in certain clinical and epidemiological situations (CKS, 2018; Del Mar, 2016 and Moore et al., 2017) there are concerns around their being used indiscriminately in the management of sore throat owing to problems such as resistance, adverse reactions or side effects, and also concerns about cost implications of unnecessary use (O’Sullivan et al., 2016; Spurling et al., 2017; Tonkin-Crine et al., 2017; Bakhit et al., 2019 and NICE, 2018). A Cochrane review by Spinks et al., (2013) found widespread use of antibiotics for sore throats was linked with only modest benefits in the reduction of duration and severity of symptoms when compared with simple analgesics. Hence NICE (2018) advocates a no-prescribing strategy for self-limiting respiratory tract infections (NICE ,2018; Rowbotahan et al., 2012 and Winchester et al., 2009). A “delayed prescription” is a strategy advocated for use with any associated uncertainty of diagnosis and probability of the development of complications (Spurling et al., 2017; NICE, 2018; Little et al., 2013).
Practice in the Community has been identified as one of the areas with the most extensive and substantial antibiotic use, (Little et al., 2013 and Simieszek et al, 2018) thus Lucy’s consultation was one demanding serious consideration of these factors.
When making decisions as to the use of antibiotics, practitioners face the challenge of balancing factors of professional judgement with customer expectations when the patient is perceived as having an expectation for antibiotic treatment. This is especially true in situations of uncertain diagnosis (Rowbotahan et al., 2012; Bakhit et al., 2018; Taylor, 2018 and Greenberg, 2018). Effective treatment and management decisions can be reached if the patient is acknowledged as a central and active participant in their health care (van der Velden et al., 2013). A shared decision approach which identifies and addresses the patient’s expectations, concerns, health beliefs, knowledge and opinions on antibiotics is widely advocated and has been linked with a reduction in antibiotic prescribing in primary care (Coxeter et al., 2015). Practitioner care and reassurance has been linked with greater patient satisfaction and may be more effective than a prescription for antibiotics