Internet-based training could help in the fight against antibiotic resistance

July 2013

Antibiotic prescribing rates for acute respiratory tract infections could be significantly lowered using internet-based training for clinicians, new research has shown.

A study, conducted by the Universities of Southampton and Cardiff with European partners of the GRACE consortium, and published in The Lancet has shown an internet-based training programme to be effective in reducing antibiotics prescribing rates by as much as 62 per cent.

Professor Christopher Butler, Cardiff University lead for the study, comments: “Antibiotic resistance is one of the greatest threats to human health, and using our existing antibiotics more carefully is essential to the sustainability of health care delivery around the world. Patients generally don’t want to take powerful medicines that have very little chance of helping them, and so the challenge is to communicate effectively the costs and benefits of antibiotic treatment and promote effective self-management, as well as better identifying those patients who are likely (and unlikely) to benefit from antibiotic treatment. The more we take unnecessary antibiotics, the more we needlessly drive up antibiotic resistance.

"Our study has shown that enhanced communication between clinicians and patients and a simple point of care finger prick blood test are major keys to reducing antibiotic prescribing that does not benefit patients. We have also shown that clinicians can be effectively trained in these techniques using the internet, which is cost effective with great potential reach."

Lower respiratory tract infections (LRTI), such as chest infections like bronchitis, are one of the most common acute illnesses treated in primary care in developed countries. Although viruses are believed to cause most of these infections, there is still debate about whether or not antibiotics are beneficial for some patients in the treatment of LRTI, particularly in older patients. Meanwhile antibiotics are still being prescribed in high amounts, fuelling antibiotic resistance.

In the study, from the GRACE (Genomics to Combat Resistance against Antibiotics in Community-acquired LRTI in Europe) consortium and funded by the European Community’s Sixth Framework Programme, 246 clinical practices from six countries were recruited. They were randomised to one of four trial arms: usual care, internet-based training to use a C-reactive protein (CRP) test (an indicator test for pneumonia), internet-based training in enhanced communication skills, and combined training in both CRP and enhanced communication.

The study, supported by the National Institute for Health Research Clinical Research Network in England, showed that clinicians who received training in using the CRP test or the enhanced communications skills training significantly reduced their antibiotic prescribing rates for LRTI, compared to usual care (47 per cent and 32 per cent respectively). Furthermore, clinicians who received training in a combination of both reduced prescribing antibiotics by 62 per cent.

Additionally prescribing rates also fell for upper respiratory tract infections (e.g. colds, influenza, and throat, ear and sinus infections). These infections were not targeted by the intervention, which suggests that further modifications could be made to the internet training to better address these conditions, which would maximise the impact of training.

Further information

Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial. Prof Paul Little, Beth Stuart, Nick Francis, Elaine Douglas, Sarah Tonkin-Crine, Sibyl Anthierens, Jochen WL Cals, Prof Hasse Melbye, Miriam Santer, Michael Moore, Prof Samuel Coenen, Prof Chris Butler, Prof Kerenza Hood, Mark Kelly, Maciek Godycki-Cwirko, Artur Mierzecki, Prof Antoni Torres, Carl Llor, Melanie Davies, Mark Mullee, Gilly O'Reilly, Alike van der Velden, Adam WA Geraghty, Prof Herman Goossens, Prof Theo Verheij, Prof Lucy Yardley, on behalf of the GRACE consortium. The Lancet. Online first 31 July 2013.