Immediate and delayed antibiotic prescribing strategies used by Australian early-career general practitioners.

Background Antibiotics are overused for non-pneumonia acute respiratory tract infections (ARTIs). Aim To establish prevalence and explore associations of antibiotic prescribing strategies used by Australian early-career GPs for non-pneumonia ARTIs. Design and setting Cross-sectional analysis of data, September 2016 to December 2017, from the Registrar Clinical Encounters in Training cohort study. Method Multinomial logistic regression of antibiotic prescribing ("no prescribing", "immediate prescribing", or "delayed prescribing") to manage an ARTI. Results Of 7,156 new ARTI problems, no antibiotics were prescribed for 4,892 problems (68%), antibiotics were prescribed for immediate use for 1,614 problems (23%) and delayed antibiotics were used for 650 problems (9%). "Delayed prescribing" was used in 22% of otitis media, 16% of sinusitis, 13% of sore throat, 11% of acute bronchitis/bronchiolitis, and 5% of upper respiratory tract infection (URTI). "Delayed prescribing" was used for 29% of all prescriptions written. "Delayed prescribing" and "immediate prescribing" were associated with markers of clinical concern. "Delayed prescribing" was associated with longer duration of consultation and with fewer problems dealt with in the consultation. Conclusion Australian early-career GPs use "no prescribing" for ARTIs substantially more than established GPs, but, except for URTIs, still prescribe antibiotics in excess of validated benchmarks. They may use "delayed prescribing" more often than European GPs. They may use "delayed prescribing" to manage diagnostic uncertainty and, possibly, conflicting influences on prescribing behaviour. Consequently, the use of "delayed prescribing" may enable a transition to an environment of more rational antibiotic prescribing for ARTIs.