Improving antimicrobial stewardship in primary care

What is the problem?

Primary care is the first point of contact for, and manages the vast majority of patients with, infectious disease. Primary care is also responsible for around 75% of all health service antibiotic use. Despite encouraging recent reductions in primary care prescribing, GPs and nurses continue to overuse antibiotics, with up to 50% regarded as inappropriate.

The reasons are complex and multifactorial and include:

• Patient expectations
• Defensive clinical practice in the presence of diagnostic and prognostic uncertainty, and
• A lack of evidence regarding how to protect patients from acquiring antibiotic resistant infections

How are we addressing this problem? 

The team led by Professor Alastair Hay (GP and Professor of Primary Care, Bristol Medical School) conducts multidisciplinary research to:

• Develop and evaluate the clinical and cost effectiveness of interventions to prevent infection (including antibiotic resistant infection) transmission and acquisition in the community
• Develop and evaluate the clinical and cost effectiveness of interventions to promote self-care of infections at home
• Improve the targeted and effective use of antibiotics in primary care
• Investigate the relationship between primary care prescribed antibiotics and antimicrobial resistance
• Develop and evaluate the clinical and cost effectiveness of interventions to reduce the severity of infection associated symptoms and
• Understand the social and cultural influences on the management of infections by clinicians, patients and carers, including health care utilisation, prescribing practices, and clinician-patient/carer communication

Outcome and next steps

The team have published their findings widely. Research studies, such as these (and others), along with the cooordinated action of the UK government, Chief Medical Officers, NHS policy makers, National Institute of Health and Care Excellence (NICE), the pharmaceutical industry, GPs, nurses, patients and academics, has seen the number of antibiotics prescribed in UK primary care fall substantially last year.

The team strives to find ways of reducing antibiotic prescribing and this is a key strategy to mitigate against the threat of AMR. Prof Hay is a member of the NICE Management of Common Infections committee and developing guidelines to support the strategic effort to reduce avoidable primary care antibiotic prescribing is an important step forward.