Promoting shortest effective antibiotic course lengths for uncomplicated infections (South East region) (2025)

NHS England (South East Region) Collaborative

Project summary

Antibiotic resistance is a growing global health threat, and reducing unnecessary antibiotic exposure is critical to preserving antimicrobial effectiveness. Shorter antibiotic courses for uncomplicated infections have been shown to be as effective as longer durations, with added benefits of minimising side effects, environmental impact, and development of resistance. Aligning with the UK 5-year action plan for antimicrobial resistance (AMR), NHS England’s South East (SE) region identified shortest effective course lengths as a regional antimicrobial stewardship (AMS) priority in 2022, driven by PrescQIPP data. At the time, the SE was the second-lowest performing region for prescribing five-day courses of amoxicillin 500mg capsules, with only 33% of prescriptions being issued with five-day course lengths.

To address this, a multidisciplinary working group of AMS pharmacists and a GP from across the SE, supported by the East of England AMS team and led by the Regional AMS Lead and Project Manager, launched a regional quality improvement initiative. The team developed a suite of NICE-aligned, evidence-based resources including key prescriber messages, infographics, an evidence review bundle, and electronic prescribing guides. These were peer-reviewed, ratified, and published on FutureNHS in August 2023 for national access and local integration.

The project used a digital-first, data-driven approach to support prescribers with clear, embedded messages at the point of care. All Integrated Care Boards (ICBs) in the SE engaged with the project and promoted resources to primary care prescribers. Between August 2023 and December 2024, the resources were accessed 1,058 times, with 85% of views from outside the region—demonstrating widespread adoption. Regional five-day prescribing for amoxicillin 500mg capsules increased from 33% (July 2022) to 70% (March 2025), and variation between ICBs dropped by 4%. Five-day courses for doxycycline 100mg capsules increased from 11% to 32%, flucloxacillin 500mg capsules increased from 11% to 27%, (making SE the best-performing region), and phenoxymethylpenicillin 250mg tablets increased from 19% to 40%. Nationally, prescribing of five-day courses rose by 29% for amoxicillin, 22% for doxycycline, 11% for flucloxacillin, and 21% for phenoxymethylpenicillin.

This regional collaborative approach has informed and shaped national policy. It was adopted into the NHS England National Medicines Optimisation Opportunities 2023/24 as one of 15 key priorities and aligns with the national overprescribing review principles. Clinicians report increased confidence, and patients benefit from safer, more appropriate prescribing. The project has become a blueprint for digital, sustainable, value-based AMS interventions—demonstrating the power of regionally led innovation in driving national improvement.