Antibiotic Stewardship: Why We Don't Always Prescribe Antibiotics

Antibiotics only work against bacterial infections — they have no effect on viral illnesses like colds, flu, and most sore throats. When antibiotics are prescribed when they are not needed, bacteria develop resistance, and the drugs become less effective for everyone. Abby Health clinicians follow antibiotic stewardship principles developed by NPS MedicineWise and consistent with RACGP guidelines: prescribing antibiotics only when there is a clinical need, and considering swabs, cultures, or a delayed prescription when appropriate.

What antibiotic stewardship means

Antibiotic stewardship is the clinical and public health effort to ensure antibiotics are used correctly — the right drug, at the right dose, for the right duration, only when genuinely needed. It is a shared responsibility across every clinician, every patient, and every consult. NPS MedicineWise, Australia's independent medicines authority, has led national stewardship programmes for more than two decades, and their principles guide how Abby clinicians approach infection management.

The stakes are high. Antimicrobial resistance — the process by which bacteria evolve to survive antibiotic treatment — is one of the most significant threats to global health identified by the World Health Organization. When antibiotics are overprescribed, bacteria that survive treatment pass on resistant traits. The drugs that protect all of us become less effective over time.

Why viral infections don't need antibiotics

Many of the most common illnesses Australians seek care for are caused by viruses, not bacteria. Colds, most sore throats, most coughs, influenza, and many ear infections in adults are viral. Antibiotics do not act on viruses. Taking an antibiotic for a viral infection will not shorten your illness, will not prevent you from infecting others, and does carry a risk of side effects — including disruption to your gut microbiome and, over time, contributing to resistance in the broader community.

Your Abby clinician will take a careful history and, where relevant, examine you to determine whether your infection is more likely to be bacterial or viral. That clinical assessment — not an assumption based on symptoms alone — guides the decision.

When antibiotics are the right call

There are bacterial infections for which antibiotics are clinically indicated, and your Abby clinician will prescribe them when there is a genuine need. Common examples include confirmed or clinically likely bacterial chest infections, urinary tract infections with bacterial symptoms, and skin infections with signs of bacterial involvement. The clinical picture — not the request — determines the prescription.

Where there is diagnostic uncertainty, your clinician may recommend a swab or a urine or blood test before prescribing. This is not a delay — it is good medicine. Confirming the cause of an infection before committing to a course of antibiotics means the right drug is used, at the right strength, for the right duration. You can read more about how pathology referrals work in an online consult in our guide to Prescriptions and Medications.

What a delayed prescription means

In some cases — where a bacterial infection is possible but not confirmed, or where the illness may resolve without treatment — a clinician may issue a delayed prescription. This means you receive a prescription that you hold and only fill if your symptoms worsen or do not improve within a defined period. This approach is endorsed by the RACGP and by NPS MedicineWise as a way to reduce unnecessary antibiotic use while keeping you safe.

A delayed prescription is not a refusal to help. It is a clinically considered approach that your doctor will explain clearly during your consult.

How Abby clinicians approach symptomatic management

For viral infections, the most effective treatment is often symptomatic: rest, hydration, and medications that address fever and discomfort rather than the infection itself. Your clinician may recommend specific over-the-counter options, advise on warning signs that would warrant a follow-up, and discuss when to seek urgent care.

Abby clinicians are also able to issue pathology referrals and prescribe ongoing medications for patients with established conditions. If your clinical picture suggests antivirals — a separate class of medications that act on viruses rather than bacteria — may be appropriate, your clinician will discuss that option with you.

What to expect if your clinician doesn't prescribe antibiotics

If your Abby clinician determines that antibiotics are not clinically indicated for your infection, they will explain why. You will not leave the consult without a clear plan — whether that is symptomatic management advice, a pathology referral, a delayed prescription, a follow-up booking, or a combination. The decision not to prescribe is always explained, never dismissive.

If you want to understand the broader framework for what Abby can and cannot prescribe, see what Abby can and can't prescribe online safely.

How to get the most from your infection consult

When you book for an infection-related concern, it helps to note how long you have had symptoms, whether they are improving or worsening, whether you have a fever, and whether you have taken any medications already. Abby AI, our medical AI, will gather this history before your consult so your clinician starts fully informed. Abby AI does not prescribe or diagnose — it prepares a structured clinical brief so the clinician can make the right call faster.

Appointments are bulk billed for eligible patients. Book through abbyhealth.app/book.

Frequently asked questions

Can I request antibiotics even if my clinician doesn't think I need them?

You can raise the question, and your clinician will always explain their reasoning. However, Abby clinicians follow stewardship principles and cannot prescribe medications that are not clinically indicated. Prescribing antibiotics without a clinical basis would not be safe — for you or for the broader community.

How do I know if my infection is bacterial or viral?

Symptoms alone are rarely definitive. A clinical assessment — history, duration, severity, associated features — combined with a swab or test where appropriate gives the clearest picture. Your clinician will guide you through this during your consult.

What if I have been prescribed antibiotics for this same infection before?

Previous prescriptions do not automatically indicate that a new prescription is needed. Each episode is assessed on its own clinical merits. Your clinician will take your history, including previous treatments, into account as part of their assessment.

Is there a cost to see an Abby clinician for an infection?

Appointments are bulk billed for eligible patients. See how to get a prescription online in Australia for more on the prescription process, including what to expect after your consult.

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