Resources

A list of resources for prescribers and references to evidence

Different types of resources provided across the Antibiotic Optimisation website are listed below.

More information about how and why to use the three promoted strategies to optimise antibiotic use can be found on the main pages for prescribers:

  1. Discussing antibiotics with patients
  2. Using POC CRP testing
  3. Using back-up/delayed antibiotic prescriptions.

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Here are some other resources helpful for optimising antibiotic prescribing:

  • TARGET Antibiotic Toolkit - 'Treat Antibiotics Responsibly, Guidance, Education, Tools' - a set of resources for primary care teams to promote prudent antibiotic prescribing. The resources include patient leaflets, resources for clinical and waiting areas, audit toolkits, self-assessment checklists and action plans; training resources (such as webinars).

 

 

  • STAR online training - 'Stemming the Tide of Antibiotic Resistance' - an online training on practical techniques for improving consultations for common infections; provided as part of Clinical Professional Development.

 

 

 

The following websites provide data on antibiotic prescribing rates in general practices and CCGs, and show how they compare locally and nationally:

  • Fingertips - Practice and CCG-level prescribing data, published quarterly and compared nationally.
    (For practice-level data, follow the link, then in the top bar select 'Antibiotic Prescribing'; in Area Type select ‘GP’; in Areas Grouped By select ‘CCGs (2018/19)’; in ‘CCGs (2018/19)’ select your CCG. Your practice will be listed in the data table below.)

 

  • OpenPrescribing - Practice and CCG-level prescribing data, published monthly (with a longitudinal trend); compared to other practices within the same CCG.
    (For practice-level data, use the link, select your practice, then select 'Antimicrobial Stewardship' measures.)

 

  • NHS England Dashboard - CCG-level data related to antibiotic prescribing and related quality targets; the NHS England Antibiotic Quality Premium Monitoring Dashboard is produced by the NHS Business Services Authority to support NHS England in monitoring CCG performance in the delivery of the Antibiotic Quality Premium.

References

  1. Little P, Stuart B, Francis N, Douglas E, Tonkin-Crine S, Anthierens S, Cals JW, Melbye H, Santer M, Moore M, Coenen S, Butler C … Yardley L. Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial. The Lancet. 2013; 382(9899):1175-82. https://doi.org/10.1016/S0140-6736(13)60994-0
  2. Francis NA, Butler CC, Hood K, Simpson S, Wood F, Nuttall J. Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomised controlled trial. BMJ. 2009; 339:b2885. https://doi.org/10.1136/bmj.b2885
  3. Costelloe C, Lovering A, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010; 340:c2096. https://doi.org/10.1136/bmj.c2096
  4. Bakhit M, Hoffmann T, Scott AM, Beller E, Rathbone J, Del Mar C. Resistance decay in individuals after antibiotic exposure in primary care: a systematic review and meta-analysis. BMC Medicine. 2018;16(1):126. https://doi.org/10.1186/s12916-018-1109-4
  5. Van Hecke O, Fuller A, Bankhead C, Jenkins-Jones S, Francis N, Moore M, Butler C, Wang K. British Journal of General Practice. 2019; 69:686. https://doi.org/10.3399/bjgp19X705089    
  6. Cabral C, Ingram JC, Hay AD, Horwood JP. “They just say everything's a virus” - parent's judgment of the credibility of clinician communication in primary care consultations for respiratory tract infections in children: A qualitative study. Patient Education and Counseling. 2014; 95:248-253. https://doi.org/10.1016/j.pec.2014.01.010
  7. Mustafa M, Wood F, Butler CC, Elwyn G. Managing expectations of antibiotics for upper respiratory tract infections: a qualitative study. The Annals of Family Medicine. 2014;12(1):29-36. http://www.annfammed.org/content/12/1/29
  8. Heritage J, Elliott MN, Stivers T, Richardson A, Mangione-Smith R. Reducing inappropriate antibiotics prescribing: the role of online commentary on physical examination findings. Patient Education and Counseling. 2010;81(1):119-25. https://doi.org/10.1016/j.pec.2009.12.005
  9. Mangione-Smith R, McGlynn EA, Elliott MN, Krogstad P, Brook RH. The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior. Pediatrics. 1999;103(4 Pt 1): 711–718. https://doi.org/10.1542/peds.103.4.711
  10. Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats. BMJ. 1998;317(7159):637-42. https://doi.org/10.1136/bmj.317.7159.637
  11. Thompson M, Vodicka TA, Blair PS, Buckley DI, Heneghan C, Hay AD. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ. 2013;347. https://www.bmj.com/content/347/bmj.f7027
  12. Little P, Williamson I, Warner G, Gould C, Gantley M, Kinmonth A. Open randomised trial of prescribing strategies in managing sore throat. BMJ. 1997;314(7082):722. https://www.bmj.com/content/314/7082/722
  13. Williamson IG, Rumsby K, Benge S, et al. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial. JAMA. 2007;298(21):2487-2496. https://jamanetwork.com/journals/jama/fullarticle/209649
  14. Little P, Rumsby K, Kelly J, Watson L, Moore M, Warner G, Fahey T, Williamson I. Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomized controlled trial. JAMA. 2005; 22;293(24):3029-35. https://jamanetwork.com/journals/jama/article-abstract/201123
  15. Little P, Stuart B, Moore M, Coenen S, Butler CC, Godycki-Cwirko M, Mierzecki A, Chlabicz S, Torres A, Almirall J, Davies M. Amoxicillin for acute lower-respiratory-tract infection in primary care when pneumonia is not suspected: a 12-country, randomised, placebo-controlled trial. The Lancet Infectious Diseases. 2013;13(2):123-9. https://doi.org/10.1016/S1473-3099(12)70300-6   
  16. Side effects ‘1 in 10 people’ - British National Formulary: Phenoxymethylpenicillin. Available on: https://bnf.nice.org.uk/drug/phenoxymethylpenicillin.html#sideEffects
  17. Butler CC, Simpson SA, Dunstan F, Rollnick S, Cohen D, Gillespie D, Evans MR, Alam MF, Bekkers MJ, Evans J, Moore L. Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial. BMJ. 2012; 344:d8173. https://doi.org/10.1136/bmj.d8173
  18. Köchling A, Löffler C, Reinsch S, Hornung A, Böhmer F, Altiner A, Chenot JF. Reduction of antibiotic prescriptions for acute respiratory tract infections in primary care: a systematic review. Implementation Science. 2018;13(1):47. https://implementationscience.biomedcentral.com/articles/10.1186/s13012-018-0732-y
  19. Tonkin-Crine SK, San Tan P, van Hecke O, Wang K, Roberts NW, McCullough A, Hansen MP, Butler CC, Del Mar CB. Clinician‐targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: an overview of systematic reviews. Cochrane Database of Systematic Reviews. 2017(9). https://doi.org/10.1002/14651858.CD012252.pub2
  20. O'Sullivan JW, Harvey RT, Glasziou PP, McCullough A. Written information for patients (or parents of child patients) to reduce the use of antibiotics for acute upper respiratory tract infections in primary care. Cochrane Database of Systematic Reviews. 2016(11). https://doi.org/10.1002/14651858.CD011360.pub2
  21. Macfarlane J, van Weel C, Holmes W, Gard P, Thornhill D, Macfarlane R, Hubbard R. Reducing antibiotic use for acute bronchitis in primary care: blinded, randomised controlled trial of patient information leaflet. BMJ. 2002; 324(7329):91-4. https://www.bmj.com/content/324/7329/91.1
  22. Bunten AK, Hawking MKD, McNulty CAM. Patient information can improve appropriate antibiotic prescribing. Nursing In Practice. 2015; 82:61-3. https://www.nursinginpractice.com/patient-information-can-improve-appropriate-antibiotic-prescribing
  23. Gulliford MC, Prevost AT, Charlton J, Juszczyk D, Soames J, McDermott L, Sultana K, Wright M, Fox R, Hay AD, Little P. Effectiveness and safety of electronically delivered prescribing feedback and decision support on antibiotic use for respiratory illness in primary care: REDUCE cluster randomised trial. BMJ. 2019; 13;364:l236. https://doi.org/10.1136/bmj.l236
  24. NICE Clinical Guidelines [CG191] Pneumonia in adults: diagnosis and management. 2014.  https://www.nice.org.uk/guidance/cg191
  25. NICE Medtech innovation briefing [MIB81] Alere Afinion CRP for C-reactive protein testing in primary care. 2016. https://www.nice.org.uk/advice/mib81
  26. Aabenhus R, Jensen JU, Jørgensen KJ, Hróbjartsson A, Bjerrum L. Biomarkers as point‐of‐care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care. Cochrane Database of Systematic Reviews. 2014(11). https://doi.org/10.1002/14651858.CD010130.pub2
  27. Cals JWL, Butler CC, Hopstaken RM, Hood K, Dinant G. Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial. BMJ. 2009; 338:b1374. https://doi.org/10.1136/bmj.b1374
  28. Butler CC, Gillespie D, White P, Bates J, Lowe R, Thomas-Jones E, Wootton M, Hood K, Phillips R, Melbye H, Llor C. C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. New England Journal of Medicine. 2019; 381(2):111-20. https://doi.org/10.1056/NEJMoa1803185
  29. Little P, Moore M, Kelly J, Williamson I, Leydon G, McDermott L, ... Stuart B. Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial. BMJ. 2014; 348:g1606. https://doi.org/10.1136/bmj.g1606
  30. Little P, Stuart B, Hobbs FR, Butler CC, Hay AD, Delaney B, ... Everitt H. Antibiotic prescription strategies for acute sore throat: a prospective observational cohort study. The Lancet Infectious Diseases. 2014; 14(3):213-219. https://doi.org/10.1016/S1473-3099(13)70294-9  
  31. Little P, Stuart B, Smith S, Thompson MJ, Knox K, van den Bruel A, ... Mant D. Antibiotic prescription strategies and adverse outcome for uncomplicated lower respiratory tract infections: prospective cough complication cohort (3C) study. BMJ. 2017; 357:j2148.  https://doi.org/10.1136/bmj.j2148
  32. Spurling GK, Del Mar CB, Dooley L, Foxlee R, Farley R. Delayed antibiotic prescriptions for respiratory infections. Cochrane Database of Systematic Reviews. 2017(9). https://doi.org/10.1002/14651858.CD004417.pub5