An integrated approach to antimicrobial stewardship (AMS) in the community setting in Ireland is central to reducing unnecessary antibiotic use. All healthcare professionals have a role to play. AMS in the community cannot be a siloed effort. It requires integration across prescribers, pharmacists and nursing teams to reduce unnecessary antibiotic use in line with patient safety. The recently updated HSE AMRIC PCRS prescriber level reports deliver enhanced insights, clearer targets and new opportunities to optimise antibiotic use in community settings.

What’s behind the report?

• The prescriber level reports include a summary of antibiotic prescriptions dispensed and reimbursed for General Medical Services (GMS) patients on an individual prescriber’s GMS panel;
• Data sourced from the HSE PCRS database covering the GMS scheme (~30% of the population);
• Quarterly reports issued to ~2,250 GMS prescribers (prescribers with more than 100 GMS patients on their GMS panel);
• Since its launch in 2019, this initiative has supported a significant shift toward Green antibiotic prescribing in Ireland, resulting in the achievement of EU targets; and
• It is hoped this new version of the report will build on the positive progress to date and target a reduction in the overall rate of antibiotic use in line with ambitious EU targets for 2030.

Key areas of focus for AMS in the community setting

Understanding the AMS areas targeted in the new individualised GP report (as outlined below), enables community pharmacists to support and engage with prescribers more effectively. This will promote consistent patient messaging across community healthcare settings.

1. Reduce antibiotic prescribing rate: 2026 target: 36 or fewer prescriptions per 100 GMS patients per quarter;
2. Reduce % Red antibiotics: Red antibiotics should be avoided as first line treatment options in community setting as they have more significant adverse effect profiles and drug-drug interactions.

2026 target: 29% or less Red (see Image 1); and

Image 1: Preferred antibiotic use in the community Red Green table

Source: antibioticprescribing.ie > Community Guidelines > Preferred antibiotic use in the community — Red Green Table.

3. Reduce prescriptions for Respiratory Tract Infection (RTI) with duration greater than five days; If antibiotics are required, strive for five days for RTI. A seven-day course for RTI is no longer recommended in primary care. A major new focus is reducing duration for RTI: amoxicillin 500mg capsules are used as a proxy in the new report. In 2025, 51% of GMS prescriptions for this presentation of amoxicillin exceeded the recommended five days. Shorter courses are equally effective and reduce unnecessary antibiotic exposure. It is anticipated that over the coming months community pharmacists will see a shift in the duration of antibiotic prescribed for RTI to five-day duration.

2026 target: 10% or less.

Key updates in the new GP report design

The new report design provides GPs with actionable, data driven feedback at a quarterly frequency. A summary table (see Image 2) links quarterly antibiotic prescribing data to targets, peer comparison and actions.

Image 2: Key features of new prescriber antibiotic report

Source: HSE

In the new report design and based on feedback from GPs, quarterly data replaces annual aggregates. The three-year trend graphs allow GPs to better track change in their prescribing practice.

Another key aspect of the updated report is a strong focus on reducing prescribing of antibiotics in children aged 0-6 years. It is common for this preschool age group to have 10-12 viral infections yearly as their immune systems are still developing. These infections become less common as they get older. Antibiotics are not indicated in many of these viruses, often giving no benefit to the patient and can cause harm when unnecessarily prescribed. The new report tracks individual prescribers rate of antibiotic prescribing for this age group over time, alongside the national rate, allowing identification of variation and opportunities to reduce unnecessary prescribing.

Dr Edel Doorley, AMRIC GP Clinical Lead, says: “The updated AMRIC PCRS reports provides great data to reflect on my prescribing practices. It’s a great learning tool to ensure I am utilising HSE antibiotic guidelines and prescribing antibiotic appropriately in line with my peers. Within our practice we use it as a discussion tool to promote AMS amongst all GPs within the practice.”

Why this matters for community pharmacists

In the months ahead, pharmacists will see increasing alignment between prescribing behaviour, patient expectations, and national AMS goals. Pharmacists can support and lead on AMS through their engagement with prescribers and patients in the community setting.

Dr Doorley emphasises the key role for community pharmacy in supporting AMS: “As a GP, I always value pharmacists supporting AMS within my local community, we share a common goal of wanting the best outcome for our patients and that includes appropriate antibiotic prescribing while minimising harm to patients. Community pharmacists are central to recognising evidence-based practices, empowering patients with important patient education and identifying opportunities to optimise antibiotic use. Their role is vital to promoting AMS and safeguarding continued effectiveness of these vital medicines for future generations. GPs and pharmacists working collaboratively in the community are key to reducing antimicrobial resistance (AMR) whilst optimising patient outcomes.”

• Reinforce five-day antibiotic durations for RTIs during dispensing;
• Counsel parents on viral RTIs in young children and when antibiotics aren’t needed, provide self-care and safety netting advice;
• Flag prolonged durations or unusual prescribing patterns to prescribers; and
• Use consistent AMS messaging when counselling patients and discussing expectations, harms and benefits of antibiotics in day-to-day practice.

Each quarter, the HSE AMRIC team shares educational updates with pharmacists via the Pharmacist Antimicrobial Stewardship Network (PAMS-net) and the IPU Newsletter. This ensures consistent, system-wide stewardship messaging. If you are not already a member, you can keep up-to-date by joining the PAMS-net (see QR code). Joining the network is simple and open to all pharmacists with an interest in responsible antimicrobial use.