southampton

Project overview

Background. One in three people see doctors or nurses each year with common infections (colds, flu, chest, ear, sinus, skin, and urine infections). Half receive antibiotics and the proportion prescribed has got bigger in COVID. Over-use of antibiotics from general practices is the leading driver of antimicrobial resistance (AMR). AMR is one of the main threats to global health., and could make most medical care impossible (e.g. operations, cancer care). There is an urgent need to make and implement antimicrobial stewardship (AMS) interventions that work.

NICE says most people with common infections should either not get antibiotics or receive a back-up or delayed prescription (to use if the illness gets much worse). However, doctors and nurses have few tools to help avoid treating people at low risk, nor target antibiotics to people at highest risk. Past research shows that tools that help doctors or nurses decide if antibiotics are needed (‘decision aids’) can work well and are safe. They use standard data that doctors or nurses collect, and provide an output that it is easy to discuss with patients.

We showed that a decision-aid that we developed for sore throat (FeverPAIN) worked: it reduced prescribing by 30%, improved symptom control, was safe, and was liked by doctors and nurses. The research needed to develop these tools for a wide range of infections has now been done, but they need to be developed as ‘apps’ like FeverPAIN that doctors and nurses can use.

We are now making the first versions of these tools. These will then need to be merged into a larger evidence based package which will be cover much more that previous studies - in aiming to tackle all common infections in adults and children.

Aim. To develop an AMS intervention package to limit the threat of AMR for all common infections in primary care.

Methods. We will develop guidance, online training and support to help make best use of antibiotics - when and how to use immediate, no and delayed prescribing strategies. This will include:

a) training clinicians to use interactive clinic-based discussion with patients using the decision-tools to target antibiotic prescribing, and patient support materials;

b) ‘in-house’ peer-led audit of antibiotic prescribing.

We will work closely with prescribers (on decision-tools) and patients (leaflets, online materials to make sure we learn how to engage them optimally in using the intervention, and that the tools/materials are understandable, relevant to their current contexts, and easy to use. This will involve both individual interviews and also larger ‘stakeholder’ group

Where next?

The package will be ready for feasibility testing and subsequently for a larger trial to test whether our approach is (cost) effective and can be rolled out in the UK.

This study is being conducted by the Primary Care Research Centre.