GP Vivas · infectious-diseases
Antimicrobial stewardship in general practice — structured viva
Structured oral on antimicrobial stewardship: defending the no-antibiotic and delayed-prescribing decisions with Cochrane numbers, running the shared decision-making conversation, the penicillin allergy label as a clinical hazard, point-of-care testing, and building a practice stewardship program that survives audit.
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Target exams
RACGP CCEFRACGP oralsMRCGP SCA
Prompt
The examiner opens: 'Your practice dispenses antibiotics at twice the regional median. Walk me through what you would actually change on Monday morning.' The viva branches through the prescribing decision, the expectation conversation, the allergy label, diagnostics, and the practice program.
Stem
You are the GP. The practice partner says: 'Patients complain if we don't give something. Stewardship is a hospital problem.' [13]
References14ShowHide
- [1]Spurling GK, Dooley L, Clark J, et al. Immediate versus delayed versus no antibiotics for respiratory infections Cochrane Database Syst Rev, 2023.PMID 37791590
- [2]Stuart B, Hounkpatin H, Becque T, et al. Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis BMJ, 2021.PMID 33910882
- [3]Little P, Rumsby K, Kelly J, et al. Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomized controlled trial JAMA, 2005.PMID 15972565
- [4]Coxeter P, Del Mar CB, McGregor L, et al. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care Cochrane Database Syst Rev, 2015.PMID 26560888
- [5]Tonkin-Crine SK, Tan PS, van Hecke O, et al. Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: an overview of systematic reviews Cochrane Database Syst Rev, 2017.PMID 28881002
- [6]Meeker D, Linder JA, Fox CR, et al. Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial JAMA, 2016.PMID 26864410
- [7]Xu AXT, Brown K, Schwartz KL, et al. Audit and Feedback Interventions for Antibiotic Prescribing in Primary Care: A Systematic Review and Meta-analysis Clin Infect Dis, 2025.PMID 39657007
- [8]Trubiano JA, Vogrin S, Chua KYL, et al. Development and Validation of a Penicillin Allergy Clinical Decision Rule JAMA Intern Med, 2020.PMID 32176248
- [9]Blumenthal KG, Lu N, Zhang Y, et al. Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study BMJ, 2018.PMID 29950489
- [10]Van Hecke O, Bjerrum L, Gentile I, et al. Guidance on C-reactive protein point-of-care testing and complementary strategies to improve antibiotic prescribing for adults with lower respiratory tract infections in primary care Front Med (Lausanne), 2023.PMID 37324137
- [11]Verbakel JY, Burvenich R, D'hulster E, et al. A clinical decision tool including a decision tree, point-of-care testing of CRP, and safety-netting advice to guide antibiotic prescribing in children with acute illness (ARON): a cluster-randomised controlled trial Lancet, 2025.PMID 41016406
- [12]Sanchez GV, Fleming-Dutra KE, Roberts RM, et al. Core Elements of Outpatient Antibiotic Stewardship. MMWR Recomm Rep, 2016.PMID 27832047
- [13]McCullough AR, Pollack AJ, Plejdrup Hansen M, et al. Antibiotics for acute respiratory infections in general practice: comparison of prescribing rates with guideline recommendations Med J Aust, 2017.PMID 28701117
- [14]Krishna MT, Huissoon AP, Li M, et al. Evaluation and Management of Penicillin Allergy: A Review. JAMA, 2019.PMID 29028276