Supporting Targeting Of antibiotics in Primary care to combat AMR using decision aids (STOP AMR – decision aids).

Background. One in three people see doctors or nurses each year with common infections, such as colds, flu, chest, ear, sinus and urine infections. Half of these receive antibiotic, and more since the COVID-pandemic; but antibiotics mostly don’t help. Overuse of antibiotics causes antibiotic resistance, where antibiotics no longer work well for infections. Antibiotic resistance is increasing and is a big public health threat, leading to serious infections becoming untreatable. For most infections NICE guidelines recommends no antibiotics, or receiving a back-up or delayed prescription (use if the infection gets much worse), or immediate antibiotics for severe infections. Reviews have identified decision tools to help guide prescribing (‘decision aids’) potentially as one of the most effective ways of reducing antibiotic prescribing. Research evidence has also become available from a range of studies in infections that could be used to develop such decision aids. No studies that have tried to reduce antibiotic prescribing in general practice have worked with clinicians and patients to develop such decision tools for the range of common infections in all ages.

Aim. To develop preliminary version of decision aids to help doctors, nurses and patients make best use of antibiotics for common infections in primary care. 

Methods.

We will develop preliminary versions of decision tools which will use standard information available to GPs and nurses in routine consultations.

The output of each decision aid will provide a recommendation: to use immediate antibiotics for the few individuals at high risk of a bacterial infection or a poor outcome; no offer of antibiotics for people at low risk; or a delayed antibiotic prescription (where participants are asked to wait and only use antibiotics if the infections is getting worse) for those at intermediate risk.

Decision aids will be developed for the most common infections (sore throats, chest, ear, sinus and urine infections) in children and adults.

We will convene a PPI panel and also a prescriber panel stakeholder (including CCG leads, GPs, nurses, pharmacists). The stakeholder panels will provide initial guidance on the preferred form of the outputs from the tools, and also comment on the first versions of the decision aids once they have been developed.

PPI

Two named PPI individuals joined the research team from the start, and we will additionally form a small PPI panel as described above. PPI will contribute to the development stage, design, study management, interpretation of findings and dissemination.

Co-applicant

Nick Francis

Amount awarded: £3,670