Table 2 Verbatim examples of how the benefits and harms of antibiotics for ARIs were presented by GPs within the consultations, grouped by level of description and whether a decision aid was used

With decision aids

(n = 15)

Benefits mentioned in 15 (100%) of 15 consultations

Side-effects mentioned in 15 (100%) of 15 consultations

Resistance mentioned in 10 (67%) of 15 consultations

Mentioned to an extended level* (15/15)

Examples:

Mentioned to an extended level (7/15)

Examples:

Mentioned to an extended level (5/10)

Examples:

GP D-2-6 “All the evidence shows if we have somebody with middle ear infection like what we have got here now…if you don’t give any antibiotics the infection lasts about 3.5 days in total. If you give antibiotics it reduces that by 12 h. It can cut off about 12 h of the symptoms by giving antibiotics, so giving antibiotics is of limited benefit” … “so, if we look at 100 kids who don’t take antibiotics, 84 will be better in 3 days. If we give antibiotics there is an extra 5 kids who would be better.”

GP B-1-2 “Most sore throats get better somewhere between 2 and 7 days and that is actually whether or not you get antibiotics. Even if it is a bacterial infection you get better without antibiotics. So the treatment options are to take antibiotics or to not take antibiotics … This is a graph that shows you how long a sore throat would last on average. So if you take antibiotics, generally the sore throat would last about 2.6 days so just over 2 and a half days. If you do not take antibiotics on average it will last about 3.3 days, so that means it last about 16 h longer without the antibiotics.”

GP A-2-1 “What we are looking at over here is what the potential complications maybe with antibiotics. So people who do not take antibiotics, 20 out of a 100 will have some other problems associated with the illness. Whether it be vomiting, diarrhoea or rash. Whereas if we give you antibiotics, you are more likely to have side effects or complications. So 7 more people out of a 100 …will have these potential side effects of these antibiotics. There are also other harms with antibiotics which can be having an allergic reaction, it can be the cost of buying them, remembering to take them…”

GP A-5-2 “The other concern as well is antibiotic resistance, meaning you know the long term implications, all the good bacteria in his system being exposed to antibiotics as well they can develop some resistance, so …[if] he got meningitis in the near time and needs antibiotics, taking some will not work, because of previous resistance”

GP B-1-2 “one of the problems that a lot of the bacteria that we have had in the community for years is getting stronger and stronger and resisting the antibiotics that we have got. So we are finding this is why this shows here that only a few people finding any benefit from taking the antibiotics because there is more and more resistance in the community… but we are finding increasingly is that the more we use them for infections that your body could probably fight them by yourself, we are actually, unfortunately, breeding bacteria that become stronger and stronger… and unfortunately at this point of time we have bacteria that is resistant to everything we have got and there is nothing new on the horizon vastly different from what we have got”

Mentioned to a basic level** (8/15)

Examples:

Mentioned to a basic level (5/10)

Examples:

GP D-2-4 “… the only problem is it increases the number of people who get rash, diarrhoea, another side effects because of the antibiotics…”

GP A-3-1 “… but then you look at the side effects and we have got all these people who do not take antibiotics obviously no side effects… and in the antibiotics you get more side effects basically. So that’s each one of these little dots is someone who gets the side effect”

GP D-2-9 “but in the big picture we are building on antibiotic resistance and you know we are coming to time where these things might not work for infections you got them to do”

GP D-2-7 “… and then you worry about antibiotic resistance and stuff like that”

Without decision aids

(n = 21)

Benefits mentioned in 7 (33%) of 21 consultations

Side-effects mentioned in 1 (5%) of 21 consultations

Resistance was not mentioned in any consultations

Mentioned to an extended level (5/7)

Examples:

No extended level mentions

GP C-1-1 “The evidence is that middle ear infection gets better 12 h to 24 h earlier if you give antibiotics and the pain is better 12 to 24 h if you give antibiotics”

Mentioned to a basic level (2/7)

Examples:

Mentioned to a basic level (1/1)

Examples:

GP F-1-5 “…in which case antibiotics won’t do anything to get you better quicker”

GP F-2-1 “And antibiotics would just give him side effects and upset his tummy”