Cardiff University-led study into antibiotic use wins research paper of the year

A study into antibiotic use led by Cardiff University and in collaboration with the University of Oxford and King’s College London has won research paper of the year.

The study, by researchers from Cardiff University’s School of Medicine and Centre for Trials Research, found a simple finger-prick blood test could help to prevent unnecessary prescription of antibiotics in patients with chronic obstructive pulmonary disease (COPD).

C-reactive Protein guided antibiotic prescribing for COPD exacerbations was published in the New England Journal of Medicine last July and has now won the overall prize for clinical research in 2019 from the Royal College of General Practitioners (RCGP).

Professor Nick Francis, formerly of Cardiff University’s School of Medicine and now at Southampton University, said: “Governments, commissioners, clinicians, and patients living with COPD around the world are urgently seeking tools to help them know when it is safe to withhold antibiotics and focus on treating flare-ups with other treatments.

“This is a patient population that are often considered to be at high risk from not receiving antibiotics, but we were able to achieve a reduction in antibiotic use that is about twice the magnitude of that achieved by most other antimicrobial stewardship interventions, and demonstrate that this approach was safe.’

Professor Chris Butler, former professor of primary care medicine at Cardiff University, said: “This rigorous clinical trial speaks directly to the pressing issues of preserving the usefulness of our existing antibiotics; the potential of stratified, personalised care; the importance of contextually-appropriate evidence about point-of-care testing in reducing unnecessary antibiotic use and enhancing the quality of care for people with the common condition of chronic obstructive pulmonary disease.’

The academics who led the study have asked the RCGP to donate the 1,000 prize money to the British Lung Foundation in memory of Margaret Barnard, a patient representative in the study who sadly died of lung cancer before the research concluded. The researchers said they wanted to recognise the valuable contribution she and other public contributors make, and also her passion for this study.

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The study found that use of a finger-prick blood test resulted in 20% fewer people using antibiotics for COPD.

More than a million people in the UK have COPD, a lung condition associated with smoking and other environmental pollutants. People living with the condition often experience flare-ups which leads to three out of four being prescribed antibiotics - but two-thirds of these are not caused by bacterial infections and antibiotics therefore have little benefit.

The finger-prick test measures the amount of C-reactive protein (CRP) - a marker of inflammation that rises rapidly in the blood in response to serious infections - to guide prescription of antibiotics.

Overuse of antibiotics is making infections harder to treat as bacteria evolve to protect themselves from attack. Antibiotic resistance is regarded as an urgent global health threat - and lessening use of these treatments is key to tackling this issue.

Professor Butler said: “Most antibiotics are prescribed in primary medical care, and many of these prescriptions do not benefit patients: point-of-care testing is being vigorously promoted as a critical solution for better targeted antibiotic prescribing.

“However, there have been virtually no trials of point-of-care tests that measure impact on clinician behaviour, patient behaviour and patient outcomes. Acute exacerbations of chronic pulmonary disease account for a considerable proportion of unnecessary antibiotic use, but a good solution to the problem in ambulatory care (where most of the antibiotics are prescribed) has not been identified until now. Ours is the first trial of biomarker guided management of AECOPD in ambulatory care and has found an effect that should be practice changing.

“We are obviously delighted on behalf of the universities involved (Cardiff, Kings and Oxford), the National Institute of Health Research Health Technology Assessment Program who funded the study, and the NIHR Clinical Research Network and Health and Care Research Wales.

“We would like to thank the GP practices who implemented the trial, and the some 600 patients who gave their time and data to implement the study and generate the findings, as well as the public contributors who helped with design and dissemination. We are deeply grateful for this wonderful recognition by the RCGP for a superb team effort by UK primary care research.’


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