Antibiotic prescribing in UK out-of-hours primary care services: a realist-informed scoping review of training and guidelines for health care professionals.

BACKGROUND: Antibiotic overuse has contributed to antimicrobial resistance, a global public health problem. In the UK, despite the fall in rates of antibiotic prescription since 2013, prescribing levels remain high in comparison with other European countries. Prescribing in out of hours care (OOH) provides unique challenges for prudent prescribing, for which professionals may not be prepared. AIM: To explore the guidance available to professionals on prescribing antibiotics for common infections in OOH primary care within the UK, with a focus on training resources, guidelines, and clinical recommendations. DESIGN AND METHOD: We carried out a realist-informed scoping review of peer-reviewed papers and grey literature focusing on antibiotic prescribing OOH (eg, clinical guidelines, training videos). General prescribing guidance was searched whenever OOH-focused resources were unavailable. Electronic databases and websites of national agencies and professional societies were searched following PRISMA standards. Findings were organised according to realist review components ie, mechanisms, contexts, and outcomes. RESULTS: 46 clinical guidelines and eight training resources were identified. Clinical guidelines targeted adults and children and included recommendations on prescription strategy, spectrum of the antibiotic prescribed, communication with patients, treatment duration, and decision-making processes. CONCLUSION: No clinical guidelines or training resources focusing specifically on OOH were found. Our results highlight a lack of knowledge about whether existing resources address the challenges faced by OOH antibiotic prescribers. Further research is needed to explore the training needs of OOH health professionals, and whether further OOH-focused resources need to be developed given the rates of antibiotic prescribing in this setting.