Preserving Antibiotics through Safe Stewardship: PASS

Since the discovery of Penicillin in the 1940s, antibiotics have transformed our ability to treat bacterial infections allowing us to live healthier, longer lives. However, we have been overusing antibiotics for decades to treat mild infections that would usually get better on their own. This overuse makes bacteria evolve so that they can survive the effect of an antibiotic making infections much harder to treat. If we are to preserve antibiotics for the future, we need to make sure that they are used carefully and not wasted. This careful use of antibiotics, making sure that those who need them can benefit but that they are not over-used is known as "antibiotic stewardship". This proposal will provide the information necessary to design approaches that can support safe antibiotic stewardship. In the first set of studies, we will measure how the public and healthcare professionals use antibiotics in the United Kingdom. We will invite people to take part in a survey called "Bug Watch." This survey will allow us to measure what different people usually do when they get common infections, for example, whether or not they visit their GP, take an antibiotic or take some other treatment. We will also use electronic patient records from a range of health settings to understand how healthcare staff are using antibiotics in general practice, hospitals and nursing homes for the elderly. Whenever we analyse medical records, they will be anonymous such that we cannot tell whose records they are. In addition to measuring how healthcare staff use antibiotics, the analyses will allow us to understand better which patients most need antibiotics to prevent complications of infection and which patients can safely not use antibiotics. Scientists who are experts in the use of electronic health records will lead this work. In the next set of studies, we will interview members of the public, patients, parents, doctors and other healthcare staff to provide a deeper understanding of what influences decisions about antibiotic use. The interviews will focus on the aspects of prescribing identified as needing improvement in the earlier work. We will also visit GP practices, nursing homes and hospital wards to observe how healthcare staff use antibiotics. The science of behaviour change allows us to understand human behaviour and how best to change this. Scientists who are experts in studying health behaviour will lead this work. A large number of studies have already tested different approaches to reducing unnecessary antibiotic use. We will summarise these studies to show what has worked in the past. We will use behavioural science theory to explain why some attempts to reduce prescribing have been successful while others failed. Our detailed analyses of how and why we use antibiotics in different settings and of what has worked in the past will help us design new combinations of approaches that can be used to improve antibiotic use across the community and health service. We will develop these new approaches to antibiotic stewardship in partnership with patients, members of the public and healthcare staff. We will also design studies to find out how well these new strategies work. We will work with designers to develop a website to explain the results of our work and to act as a practical tool to help the public, health care staff and health service planners improve antibiotic use. The work, which involves scientists from many different backgrounds, will provide excellent opportunities for training young researchers. These scientists will increase our future ability to tackle the growing problem of antibiotic resistance.