Key insights from social science research for antibiotic stewardship interventions

 

 

By Christie Cabral, Senior Lecturer, Centre for Academic Primary Care , University of Bristol

As a social anthropologist, I’ve been investigating why antibiotics are overused for over a decade and using the insights gained to develop antibiotic stewardship interventions. For World Antimicrobial Resistance (AMR) Awareness Week, I am writing about three key insights from my research.

1. The role of ‘Explanatory Models’ for illness and treatment: the influence on consulting and prescribing behaviours

Explanatory models are the set of linked ideas or theories that we each have in our minds about an illness and the possible treatments. These inform what we do as a patient, deciding whether to consult, or as a clinician deciding whether to prescribe.

The (simplified) biomedical model for the infections is of two types: viral or bacterial. Antibiotics treat bacterial infections but are ineffective for viral infections. So, it’s simple, no one … Read more

Arts and Sciences – researching the history of antibiotics in primary care

Dr Barbara Caddick
Dr Barbara Caddick

 

 

This article was originally published by the Elizabeth Blackwell Institute for Health Research. Reproduced here with kind permission.

 

The prevalence of antibiotic use in modern society is well established. Antibiotics have revolutionised medicine and how society sees – and deals with – disease. Along with concerns regarding the rise of antibiotic resistant bacteria, thought to be exacerbated by their over-use in many areas, there is a need to understand the history of their adoption and use, especially in primary care. Comprehending the many-tendrilled circumstances and behaviours that led to this point might help to inform future choices, and give some insight into future best practice.

Dr Barbara Caddick, Senior Research Associate at the Centre for Academic Primary Care (CAPC) at the University of Bristol, is well qualified for such an undertaking, with a PhD in History and extensive experience in research in Read more

Point-of-care tests to inform antibiotic prescribing

 

 

by Alastair Hay, Professor of Primary Care, Centre for Academic Primary Care, University of Bristol

This article was first published in the BMJ.

The tests have potential but more evidence is needed. 

Given the global concerns(1) about antibiotic resistance, antimicrobial stewardship is essential to preserve the future effectiveness(2) of antibiotics. Healthcare practitioners must balance public and patient health, ensuring that only patients who need antibiotics receive them, and that they receive an antibiotic to which their infection is susceptible, at the optimum time, dose, and duration. Whether to prescribe an antibiotic is a key issue for clinicians treating respiratory infections in the community.

Point-of-care tests provide results in time to inform treatment. For respiratory infections, the tests can identify the presence of a microbe(3-5) or measure markers of a host’s response to a microbe, such as C reactive protein or procalcitonin, in finger prick quantities … Read more

What are the causes of unnecessary antibiotic prescribing?

 

 

By Christie Cabral, Research Fellow, Centre for Academic Primary Care, University of Bristol

Why do parents seeking evaluation, reassurance and information about their child’s cough end up with antibiotics from their GP? Research fellow Christie Cabral looks at the evidence.

GPs see a lot of children with respiratory tract infections (RTIs), usually presenting with a cough, high temperature or both. RTIs can be distressing and disruptive for children and parents but are mostly viral illnesses that will get better on their own: there is little that a GP can do to treat them.

However, many are prescribed unnecessary antibiotics that can lead to resistant bacteria. From our previous research, we know that parents often feel uncertain about the severity of an RTI and feel that it’s safer to consult a doctor.

They are usually seeking a medical evaluation, reassurance and information to help them understand and … Read more

Prescribing and the environment

 

 

by Dr Rupert Payne, Consultant Senior Lecturer in Primary Health Care, Centre for Academic Primary Care, University of Bristol

Boots pharmacies made the mainstream news headlines in May this year when it became apparent that some prescriptions which were being prepared using an automated centralised system were being distributed using plastic bags. Lloyds pharmacies have a similar process in place.

The argument is that the centralised assembly process is more efficient and safer than the old-fashioned local approach which used paper bags. The bags can be recycled but, as many of us know, that isn’t necessarily straightforward. Given the backlash against plastic that has been seen recently, and particularly given the fact that pharmacies have always been well known for using paper bags, it is unsurprising that this change has been received negatively by consumers.

But the impact of prescribing on the environment is not just … Read more

Penicillin was discovered 90 years ago – and despite resistance, the future looks good for antibiotics

 

by Professor Alastair Hay
Professor of Primary Care
Centre for Academic Primary Care

When the NHS turned 70 this year, I was reminded of another anniversary which has had an enormous impact on healthcare over many years. Penicillin is 90 this year.

Discovered in September 1928 by Alexander Fleming, it was first used as a cure when George Paine treated eye infections with it in 1930. A method for mass production was devised by Howard Florey and Ernst Chain in 1940, and it was first mass produced in 1942, with half of that total supply used for one patient being treated for streptococcal septicaemia.

In 1944, 2.3m doses were produced in time for the Normandy landings of World War II. And it was then that the miracle of penicillin became clear. Soldiers who had previously died from septicaemia were surviving.

Expectations rose. If penicillin could cure septicaemia, what … Read more