Incidence, healthcare-seeking behaviours, antibiotic use and natural history of common infection syndromes in England: results from the Bug Watch community cohort study

On Behalf Of The Pass Research Group ,Catherine M Smith,Laura J Shallcross,Andrew C Hayward,Georgios Tsakos,Ellen B Fragaszy,Arnoupe Jhass,Jennifer S Mindell,Suzanne Hill,Susan Michie,Peter Dutey-Magni,Franziska Marcheselli,Anne Conolly,Christopher Fuller,Matthew J Ridd

doi:10.1186/s12879-021-05811-7

Abstract

BackgroundBetter information on the typical course and management of acute common infections in the community could inform antibiotic stewardship campaigns. We aimed to investigate the incidence, management, and natural history of a range of infection syndromes (respiratory, gastrointestinal, mouth/dental, skin/soft tissue, urinary tract, and eye).MethodsBug Watch was an online prospective community cohort study of the general population in England (2018–2019) with weekly symptom reporting for 6 months. We combined symptom reports into infection syndromes, calculated incidence rates, described the proportion leading to healthcare-seeking behaviours and antibiotic use, and estimated duration and severity.ResultsThe cohort comprised 873 individuals with 23,111 person-weeks follow-up. The mean age was 54 years and 528 (60%) were female. We identified 1422 infection syndromes, comprising 40,590 symptom reports. The incidence of respiratory tract infection syndromes was two per person year; for all other categories it was less than one. 194/1422 (14%) syndromes led to GP (or dentist) consultation and 136/1422 (10%) to antibiotic use. Symptoms usually resolved within a week and the third day was the most severe.ConclusionsMost people reported managing their symptoms without medical consultation. Interventions encouraging safe self-management across a range of acute infection syndromes could decrease pressure on primary healthcare services and support targets for reducing antibiotic prescribing.

Highlights

Better information on the typical course and management of acute common infections in the community could inform antibiotic stewardship campaigns
In our population of participants who completed at least 75% of surveys, we identified infection syndromes by combining reports of specific and non-specific symptoms across different days
Participants included in the analysis comprised these 782 adults and the 91 children that they registered, a total of 873

Summary

Introduction

Better information on the typical course and management of acute common infections in the community could inform antibiotic stewardship campaigns. The UK’s national action plan on tackling AMR aims to further reduce prescribing by 15% by 2024 whilst reducing the number of drug-resistant infections [4]. Achieving this aim requires identification of opportunities to safely reduce prescribing. It has been estimated that up to 23% of prescriptions in general practice, and over half of those in dental practice, are inappropriate [6, 7] This includes prescriptions for mild illnesses that would get better on their own and has led to initiatives to reduce inappropriate prescribing in primary care, and efforts to understand levels of knowledge of antibiotic stewardship amongst professionals and the general public [8, 9]. Encouraging patients to manage their symptoms without medical consultation could be an effective complementary approach to reducing antibiotic prescribing

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