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Antibiotic resistance is an increasingly serious patient safety and public health problem worldwide. The overall uptake of antibiotics in an individual and in the population has an impact on antibiotic resistance.

This is one of the greatest challenges currently facing the population’s health on a global scale
- Royal College of General Practitioners (RCGP)

In England Primary Care is responsible for 80% of all antibiotic prescriptions, and over half of these are for respiratory infections, such as sore throats and chest infections. We are therefore in need of strategies to reduce prescribing of antibiotics in UK primary care, particularly for respiratory infections.

The ongoing National Institute for Health Research School for Primary Care Research (NIHR SPCR) funded TOAST* (Treatment options without Antibiotics for Sore throat) trial aims to assess whether taking a single dose of an oral steroid medication can reduce or resolve the symptoms of sore throat in patients presenting to their GP. We also aim to assess whether oral steroids can reduce the percentage of patients going on to take a course of antibiotics for their sore throat. The findings have the potential to give GPs an alternative treatment option to offer patients for their symptoms of sore throat and therefore reduce antibiotic prescribing in primary care. 

The SPCR funded research team conducting a qualitative analysis to understand the delayed prescribing of antibiotics for respiratory tract infection in primary care** at the University of Southampton commented:

"David Cameron has today highlighted the national and international dangers of rising antibiotic resistance. It is right that the Government review this issue and the need for new antimicrobials. In order to protect the available antibiotics for our children and grandchildren we must only use antibiotics when really needed for serious infections. The School for Primary Care Research is supporting a programme of work to understand the culture of antibiotic prescribing and alternative approaches to help with patient’s symptoms. It is expected in time that this will improve the care of patients attending their GP with better symptom control and a reduction in antibiotic use. The SPCR is supporting a number of studies aimed at identifying alternative approaches for those with less severe infection. Nobody questions that those suffering from sore throats, coughs and urine infections feel really unwell and come to the doctor for help with their symptoms; but antibiotics may not be the best approach. Current research  led by Oxford, Bristol and Southampton is examining ways to help with the symptoms of sore throat, cough and urine infections to reduce the demand for antibiotics for these conditions. Work at  Southampton University has endeavoured to understand why patients consult and expectations around antibiotics, other work has explored GP prescribing behaviour to identify strategies to encourage more prudent use and prescribing. A study supported by SPCR  suggests that despite good evidence of the need for more prudent prescribing some general practitioners are not using the wait and see approach and are not aware of the different approaches available.  Not all practices have a coherent strategy for antibiotic prescribing which leads to variable threshold for antibiotics which in turn fails to deliver a consistent message to the public."

*The TOAST (Treatment options without Antibiotics for Sore throat) researchers include principle investigator Dr Gail Hayward, Dr Matthew Thompson, Professor Carl Heneghan and Dr Jane Wolstenholme from the University of Oxford, Dr Alastair Hay from the University of Bristol, and Professors Paul Little and Michael Moore from the University of Southampton.

** The Understanding the delayed prescribing of antibiotics for respiratory tract infection in primary care: a qualitative analysis researchers include principle investigator Associate Professor Geraldine Leydon, Professor Michael Moore, Professor Paul Little, Dr Lisa McDermott, Dr Claire Ballinger, Dr Eyles and Ms Rachel Ryves from the Univesity of Southampton

BBC News: Antibiotic resistance: Cameron warns of medical 'dark ages'

Dame Sally Davies to give the inaugural Elizabeth Blackwell Public Lecture at the University of Bristol.

'The drugs don’t work: the global threat of antibiotic resistance’ will be given by Dame Sally Davies FMedSci DBE FRS, Chief Medical Officer for England and Chief Scientific Adviser for the Department of Health. The event will be held on 26 November 2014, 6-7 pm, at the University of Bristol, Wills Memorial Building, Great Hall. More information.

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