Recipient organisationNIHR Southampton Biomedical Research Centre
NIHR supportRecorded as supported by this research centre
PeriodFeb 2025 — Jan 2028
In plain English
AI plain-English summary
Every week, a typical GP surgery in the UK sees four patients aged 65 and over with a chest infection that is not pneumonia—and most of them walk out with a prescription for antibiotics, despite little evidence that the drugs help. This matters because antibiotic overuse fuels resistance, making serious infections untreatable, while under-prescribing could leave older adults with longer or more severe illness. Current guidelines advise against antibiotics for most lower respiratory tract infections (LRTIs), but make an exception for older people with other medical conditions—an exception based on weak evidence. GPs have ranked infections in the elderly as their top research priority, yet no robust trial has tested whether antibiotics actually speed recovery in this group. The AFLOAT trial will randomly assign older adults with uncomplicated LRTI to receive either antibiotics or a placebo, then measure how long symptoms last. If the results show that antibiotics offer no meaningful benefit, GPs can confidently withhold them, reducing unnecessary prescriptions and slowing antibiotic resistance. If antibiotics do help, the evidence will justify targeted use. Either way, the trial will give clinicians the data they need to treat older patients safely—without guesswork.
View original technical description
Cough is the most common reason for people to see a healthcare professional and often affects older adults. ‘Chest infections’ are also known as Lower Respiratory Tract Infections (LRTIs). Pneumonia is a serious lung infection that is usually treated with antibiotics. However,most chest infections are not pneumonia,are caused by viruses,and do not respond to antibiotics. A typical GP surgery in the UK will see 4 patients each week aged 65 and over with a chest infection that is not pneumonia (uncomplicated LRTI). Most adults aged over 65 with uncomplicated LRTI currently receive antibiotics. Current guidelines advise against antibiotics for most patients with LRTI but that antibiotics should be considered in older people with other risk factors. This is because older people with other medical conditions are at greater risk of severe illness. However,there is very little evidence on whether antibiotics benefit this group of patients. In a recent survey, GPs rated ‘infections in the elderly’ as the top priority for all infection research and felt they require more evidence to guide their practice. Use 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. Antibiotic overuse also causes preventable and serious side effects. In another recent survey,most older adults were cautious about antibiotic use,side effects and that overuse can lead to antibiotics not working the next time they are needed. On the other hand,under-prescribing antibiotics may put older adults at risk of longer and more serious infections. Therefore,we want to conduct a study to make sure that patients who do not take antibiotics are no worse in terms of the time it takes them to recover from their illness. This will support clinicians in their daily practice.
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