Antimicrobial stewardship in general practice — KFP-style written assessment

KFP 1 (10 marks)

A 31-year-old office worker presents on day 3 of cough, coryza and mild sore throat. Observations normal, chest clear, FeverPAIN 1. She has a deadline at work and asks for 'anything to knock it on the head — antibiotics if you've got them'. ^[2]

1. State her antibiotic use probability under each of the three prescribing strategies, with the Cochrane figures. (3) ^[2]
2. Outline the exact content of a delayed-prescription consultation if you choose that strategy. (4) ^{[2] [3]}
3. Name the patient group in whom delayed supply performed measurably worse than immediate supply. (1) ^[3]
4. What symptom duration should she be warned to expect? (2) ^[4]

Model answers

1. Cochrane 2023: antibiotic use 93% with immediate supply versus 30% with delayed supply, and 13% with no antibiotic versus 27% with delayed supply. Satisfaction was equal for delayed versus immediate (86% vs 91%) and favoured delay over no antibiotics (87% versus 82%). ^[2]
2. Name the strategy explicitly: 'this is a back-up prescription, not a script to fill today'. State the activation threshold — for example pain or fever not settling by day 3–4 from now, or red-flag symptoms (rigors, breathlessness, unilateral facial pain). State that most people never need it. Write the earliest start date on the box. Provide written red-flag advice and a contingency review option. The individual patient data meta-analysis supports safety: symptom severity at 2–4 days identical across strategies, reconsultation reduced versus no supply (OR 0.72). ^{[2] [3]}
3. Children younger than 5 years: slightly higher follow-up symptom severity with delayed versus immediate antibiotics (adjusted mean difference 0.10). ^[3]
4. Cough rated 'at least a slight problem' lasts a mean of 11.7 days, and 25% of patients cough for 17 days or more. Antibiotics did not shorten this in the trial. ^[4]