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Local real-time surveillance of infectious disease could improve antibiotic prescribing

1 June 2018

Antimicrobial resistance is a significant threat to public health. Researchers from the University of Bristol’s Centre for Academic Primary Care and NIHR Health Protection Research Unit in Evaluation of Interventions have found promising evidence that local real-time surveillance of infectious disease, such as flu, could help GPs make better diagnostic and treatment decisions, reducing the amount of unnecessary antibiotic prescribing.

GPs are more likely to prescribe antibiotics when there is uncertainty about a diagnosis on a ‘just in case’ basis. The researchers wanted to find out whether having access to real-time information on infectious diseases circulating in their local area could help them make better decisions about diagnosis and, therefore, treatment.

In a study funded by the National Institute for Health Research’s School for Primary Care Research and published in the journal Family Practice, the researchers identified surveillance systems in the US, Canada, New Zealand, Spain and Norway that use weekly or daily emails or faxes to share locally relevant information on circulating illnesses to primary care centres. One of the systems was embedded in the electronic health record.

Their review found evidence that these systems could be effective in reducing antibiotic prescribing. One observational study showed an over two-thirds reduction in antibiotic prescribing for upper respiratory tract infections from 26.4% to 8.6%. Another, a randomised controlled trial, showed an absolute reduction of antibiotic prescribing by 5.1% during a period of moderate influenza.

Alastair Hay, Professor of Primary Care at the University of Bristol who led the study, said:

“Our research shows promising evidence that adopting a local real-time infectious disease surveillance system in the UK could help GPs reduce unnecessary antibiotic prescribing. It would be especially useful in cases where diagnosis is uncertain, for example in children presenting with symptoms of respiratory infection. If it is known that a viral infection is circulating locally, then a GP could include that information in their decision-making about diagnosis and how to treat.

“In an Editorial published in the British Journal of General Practice today, we have set out our vision of how such a system might work. Although we don’t currently have such a system in the UK, many of the necessary elements to introduce one are already in place. Any proposed system would have to undergo rigorous evaluation first to establish its clinical and cost-effectiveness, as well as any possible unintended harmful effects.”

Paper: Does locally relevant, real-time infection epidemiological data improve clinician management and antimicrobial prescribing in primary care? A systematic review by Isabel Lane, Ashley Bryce, Suzanne M Ingle and Alastair D Hay. Published in Family Practice. February 2018.

BJGP Editorial: Managing infectious disease in primary care using local, real-time surveillance? Alastair D Hay and Isabel Lane. Published in British Journal of General Practice. June 2018

Further information

About the Centre for Academic Primary Care

The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow us on Twitter: @capcbristol.

About the NIHR Health Protection Research Unit in Evaluation of Interventions

The Health Protection Research Unit in Evaluation of Interventions, based in Population Health Sciences at the University of Bristol, is part of the National Institute for Health Research (NIHR) and a partnership between University of Bristol and Public Health England, in collaboration with University College London, Cambridge Medical Research Council (MRC) Biostatistics Unit and University of the West of England. Follow us on Twitter: @HPRU_EI

About the National Institute for Health Research 

The National Institute for Health Research (NIHR): improving the health and wealth of the nation through research.

Established by the Department of Health and Social Care, the NIHR:

  • funds high quality research to improve health
  • trains and supports health researchers
  • provides world-class research facilities
  • works with the life sciences industry and charities to benefit all
  • involves patients and the public at every step

For further information, visit the NIHR website

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