Supplementary Material Author’s manuscript: Click here to view.(1.3M, pdf) Reviewer comments: Click here to view.(140K, selleckchem Vandetanib pdf) Acknowledgments The authors thank Tore Tjora for supervising the initial latent class analyses. Footnotes Contributors: MK contributed to conception and design of the study, analysed the data, interpreted the data and drafted the manuscript and consequent revisions regarding important

intellectual content. KH, GH and SØ contributed to conception and design of the study, interpretation of the data and critical revisions of the manuscript for important intellectual content. All authors approved of the final version of the manuscript. Funding: The data collection was financed by the Swedish Social Insurance Agency. Competing interests: None. Patient consent: Obtained. Ethics approval: The HAP study was approved by the Ethics Committee, University of Gothenburg, Sweden, registration number 039–08. Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: No additional data are available.
Overuse of antibiotic drugs is leading to increasing antimicrobial drug resistance. As

there are now fewer new antibiotic drugs being developed, it is important to preserve the effectiveness of presently available antibiotics for future generations.1 The Chief Medical Officer’s annual report for 20111 promoted the concept of antimicrobial stewardship, which means that unnecessary or inappropriate use of antibiotics should be avoided so as to

minimise the selection of antibiotic resistant strains of organisms. In addition to increasing antimicrobial drug resistance, the overuse of antibiotic drugs can lead to unnecessary side effects and increase future consultations for respiratory tract infections (RTIs).2 3 In primary care, RTIs are a common reason for consultation and antibiotics are frequently prescribed. RTIs account for about 60% of antibiotic prescribing in primary care.4 Previous studies showed that antibiotic utilisation at consultations for respiratory infections declined during the 1990s but has remained constant since.5 However, there has been a long-term decline in the rate of consultation for RTI in UK primary care.6 In 2008, Dacomitinib the National Institute for Health and Care Excellence (NICE) recommended that most acute RTIs, including colds, coughs, sore throats, otitis-media and rhino-sinusitis, could be managed without antibiotics and recommended that either a ‘no antibiotic’ or ‘delayed antibiotic prescribing’ strategy should be agreed for most patients.4 We recently completed a large cluster randomised trial to reduce antibiotic prescribing among general practices that contribute to the Clinical Practice Research Datalink (CPRD).