Bristol researchers aim to improve the use of antibiotics in primary care

New research led by Bristol NHS CCG and the University of Bristol, aimed at improving the quality of primary care for children with respiratory tract infections (RTIs) has been presented in London.

Carried out by the Centre for Academic Primary Care (CAPC), the TARGET programme included the largest and most rigorous set of studies of their kind. RTIs in children are the most common problem managed in primary care internationally. The programme, funded by the National Institute for Health Research Programme Grants for Applied Research Programme, was intended to give clinicians the tools they need to better care for these patients.

The programme found new evidence to help parents, primary care clinicians (doctors and nurses) and policy makers support improved antimicrobial stewardship in primary care.

The main findings of the five-year research programme are:

• Symptoms of respiratory tract infections in children last longer than many parents and clinicians expect (some for more than 21 days), and that this information is of great value to parents to help them know what to expect after seeing the doctor or nurse

• An important driver of antibiotic prescribing is clinical uncertainty – clinicians will adopt a “treat just in case” strategy when they are unsure if a child’s condition could get worse (eg need hospitalisation), and they would welcome any evidence that helps them identify which children will get worse.

• Parents value consistent advice from a trusted source, which addresses their common concerns about their child’s RTI, and would value more advice about symptom relief and more precise safety-netting advice.

• Experience and training in recognising severe RTIs, plus more evidence to identify the children at highest and lowest risk of illness deterioration, may help clinicians to identify children most and least likely to benefit from antibiotics.

• The most effective interventions to improve antibiotic use target parents and clinicians during consultations; promote clinician leadership in the intervention design; provide automatic prescribing prompts; and employ delayed prescribing.

Professor Alastair Hay, from CAPC at the University of Bristol and the Respiratory Infections Health Integration Team, led the programme. He said:

“Children with RTIs often receive antibiotics despite the fact that antibiotics will not help the majority of children’s infections. Our research has uncovered why clinicians prescribe antibiotics; what parents want from a consultation with their GP and what sorts of interventions would help improve the use of antibiotics in primary care. With antimicrobial resistance an ever growing problem, we hope our research will go some way to tackle this issue.”

As well as presenting their findings today, the researchers have launched two new websites to disseminate their findings:

For clinicians and policymakers – Detailed information about the research including published papers

For parents – A guide for parents on when to see a GP and how to care for a child with a cough