Preserving Antibiotics through Safe Stewardship: PASS

自从20世纪40年代发现青霉素以来，抗生素改变了我们治疗细菌感染的能力，使我们能够活得更健康、更长寿。然而，几十年来，我们一直在过度使用抗生素来治疗轻度感染，这些感染通常会自行好转。这种过度使用会使细菌进化，以便它们能够在抗生素的作用下存活下来，从而使感染更难治疗。如果我们要为未来保存抗生素，我们需要确保仔细使用它们，而不是浪费它们。这种谨慎使用抗生素的做法，确保那些需要抗生素的人能够受益，但又不会过度使用，这就是我们所熟知的“抗生素管理”。这项建议将提供必要的信息，以设计能够支持安全的抗生素管理的方法。在第一组研究中，我们将衡量英国公众和医疗保健专业人员使用抗生素的情况。我们将邀请人们参加一项名为“臭虫观察”的调查。这项调查将使我们能够衡量不同的人在感染常见疾病时通常会做什么，例如，他们是否去看他们的全科医生，是否服用抗生素或采取一些其他治疗。我们还将使用来自一系列健康环境的电子患者记录，以了解医护人员在全科医生、医院和养老院使用抗生素的情况。每当我们分析医疗记录时，它们都是匿名的，以至于我们无法分辨它们是谁的记录。除了衡量医护人员如何使用抗生素外，这些分析还将使我们更好地了解哪些患者最需要抗生素来预防感染并发症，哪些患者可以安全地不使用抗生素。电子健康记录使用方面的专家科学家将领导这项工作。在下一组研究中，我们将采访公众、患者、父母、医生和其他医护人员，以更深入地了解影响抗生素使用决定的因素。面谈将集中在早期工作中被确定为需要改进的处方方面。我们还将访问全科医生诊所、疗养院和医院病房，观察医护人员如何使用抗生素。行为改变的科学让我们能够理解人类的行为，以及如何最好地改变这一点。研究健康行为的科学家将领导这项工作。大量研究已经测试了减少不必要抗生素使用的不同方法。我们将对这些研究进行总结，以显示哪些研究在过去是有效的。我们将使用行为科学理论来解释为什么减少处方的一些尝试是成功的，而另一些尝试是失败的。我们对我们如何以及为什么在不同的环境中使用抗生素以及过去有效的方法的详细分析将帮助我们设计新的方法组合，这些方法可以用于改善整个社区和卫生服务的抗生素使用。我们将与患者、公众和医护人员合作，开发这些新的抗生素管理方法。我们还将设计研究，以找出这些新策略的效果如何。我们将与设计师合作开发一个网站，解释我们的工作结果，并作为一个实用工具，帮助公众、卫生保健人员和卫生服务规划者改善抗生素的使用。这项工作涉及来自不同背景的科学家，将为培训年轻研究人员提供极好的机会。这些科学家将提高我们未来解决日益严重的抗生素耐药性问题的能力。

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.