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Almost nine out of ten patients were offered over-the-counter (OTC) medicines and self-care advice under the antimicrobial stewardship criterion of the Pharmacy Quality Scheme (PQS), a study has found.
Publishing the study findings in JAC – Antimicrobial Resistance on 18 November 2025, researchers analysed the data of of 225,615 patients who presented at community pharmacies with symptoms of upper respiratory tract infection (RTI) and were reviewed with the use of the TARGET Treating Your Infection (TYI) upper respiratory tract infection (RTI) leaflet between 2022/2023 and 2023/2024.
The use of the leaflets was incentivised under the PQS in 2022/2023 and 2023/2024.
Researchers found that in 2022/2023, more than three-quarters (85%; n=97,551) of patients who were reviewed using the leaflets were offered OTC medicines, which rose to nearly nine in ten patients (89%; n=98,343) in 2023/2024.
Of those offered OTC medicines, the study results revealed that most patients accepted: 80% of patients accepted OTC medicines in 2022/2023, while 84% accepted OTC medicines in 2023/2024.
The leaflet, developed by the UK Health Security Agency and the Royal College of General Practitioners, is designed to help primary care professionals support people with self-limiting RTIs and promote antimicrobial stewardship.
The study authors said that most OTC treatment accepted by patients took the form of pain relief medication, expectorant cough syrups, throat lozenges and oral decongestants. Nasal sprays and all-in-one preparations were the least commonly offered OTC remedies, they added.
Almost all patients were offered advice on self-care for their infection: 95% of patients (n=109, 474) in 2022/2023 and 97% of patients (n=106 ,770) in 2023/2024, the researchers revealed.
They also observed that cough and bronchitis were the most common presentations, followed by sore throat and the common cold.
In 2022/2023, 43% (n=49,813) of patients were seen and managed by community pharmacy teams and did not require escalation to the pharmacist, which dropped to 39% of patients (n=42,731) in 2023/2024, the researchers found.
They also found that the number of patients signposted to another healthcare provider — most commonly their GP — fell from 12% of patients (n=13,248) in 2022/2023 to 7% of patients (n=8,250) in 2023/2024. The authors noted that the worsening of symptoms was the most common reason for escalation.
A total of 7,525 community pharmacies participated in at least one year, while 7,407 community pharmacies participated in both years, the researchers said.
The authors noted: “Implementing the TARGET TYI RTI leaflet — a primary care intervention (which was originally designed for GPs) into existing community pharmacy infrastructure proved scalable, demonstrating its national (and international) potential for antimicrobial stewardship impact.
“There has been significant improvement in antimicrobial stewardship within the community pharmacy sector, which has been driven by financial incentivisation from the PQS.”
Participation in the PQS is optional and is designed to incentivise pharmacies to deliver activities that support clinical effectiveness, patient safety and patient experience.
Heidi Wright, practice and policy lead for England at the Royal Pharmaceutical Society, commented: “These findings highlight the vital role community pharmacy teams play in antimicrobial stewardship. Pharmacy teams should continue to use effective resources like the TARGET leaflets to help patients understand when antibiotics are appropriate, reduce unnecessary use and provide consistent self-care advice.
“As more pharmacists take on independent prescribing responsibilities, their contribution to preventing inappropriate antibiotic use will only increase. Continued investment in resources and training is essential to sustain this progress and maximise community pharmacy’s contribution to tackling antimicrobial resistance.”
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