Antibiotic resistance is an increasing community problem and is related to antibiotic use. If antibiotic use could be reduced, the tide of increasing resistance could be stemmed. e-Bug is a European project involving 18 European countries, partly funded by The Directorate-General for Health and Consumers (DG SANCO) of the European Commission. It aims to develop and disseminate across Europe a junior and senior school teaching pack and web site (hosting the lesson plans and complementary games) that teach young people about prudent antibiotic use, microbes, transmission of infection, hygiene and vaccines. The aim of e-Bug is to increase young people's understanding, through enjoyable activities, of why it is so important to use antibiotics correctly in order to control antibiotic resistance, and to have good hand and respiratory hygiene to help reduce the spread of infection. Within the senior school pack the sexual transmission of infections has also been included, as the peak age of chlamydial infection is in 16-24 year olds. Teachers, young people and the consortium of 18 countries were closely involved with agreeing learning outcomes and developing the resource activities. Young people helped create the characters and microbe artwork. The resources have been translated, adapted for and disseminated to schools across 10 countries in Europe, and endorsed by the relevant government departments of health and education. The web site has been accessed from >200 countries. The resources will be translated into all European Union languages, and have been used to promote European Antibiotic Awareness Day and better hand and respiratory hygiene during the influenza pandemic in 2009.
The failure to reduce the Campylobacter contamination of intensively reared poultry may be partially due to Campylobacter resisting disinfection in water after their internalization by waterborne protozoa. Campylobacter jejuni and a variety of waterborne protozoa, including ciliates, flagellates, and alveolates, were detected in the drinking water of intensively reared poultry by a combination of culture and molecular techniques. An in vitro assay showed that C. jejuni remained viable when internalized by Tetrahymena pyriformis and Acanthamoeba castellanii for significantly longer (up to 36 h) than when they were in purely a planktonic state. The internalized Campylobacter were also significantly more resistant to disinfection than planktonic organisms. Collectively, our results strongly suggest that protozoa in broiler drinking water systems can delay the decline of Campylobacter viability and increase Campylobacter disinfection resistance, thus increasing the potential of Campylobacter to colonize broilers.
ObjectivesTo determine whether local trainer-led TARGET antibiotic interactive workshops improve antibiotic dispensing in general practice.MethodsUsing a McNulty–Zelen-design randomized controlled trial within three regions of England, 152 general practices were stratified by clinical commissioning group, antibiotic dispensing rate and practice patient list size, then randomly allocated to intervention (offered TARGET workshop that incorporated a presentation, reflection on antibiotic data, promotion of patient and general practice (GP) staff resources, clinical scenarios and action planning, 73 practices) or control (usual practice, 79 practices). The primary outcome measure was total oral antibiotic items dispensed/1000 patients for the year after the workshop (or pseudo-workshop date for controls), adjusted for the previous year’s dispensing.ResultsThirty-six (51%) intervention practices (166 GPs, 51 nurses and 101 other staff) accepted a TARGET workshop invitation. In the ITT analysis total antibiotic dispensing was 2.7% lower in intervention practices (95% CI −5.5% to 1%, P = 0.06) compared with controls. Dispensing in intervention practices was 4.4% lower for amoxicillin/ampicillin (95% CI 0.6%–8%, P = 0.02); 5.6% lower for trimethoprim (95% CI 0.7%–10.2%, P = 0.03); and a non-significant 7.1% higher for nitrofurantoin (95% CI −0.03 to 15%, P = 0.06). The Complier Average Causal Effect (CACE) analysis, which estimates impact in those that comply with assigned intervention, indicated 6.1% (95% CI 0.2%–11.7%, P = 0.04) lower total antibiotic dispensing in intervention practices and 11% (95% CI 1.6%–19.5%, P = 0.02) lower trimethoprim dispensing.ConclusionsThis study within usual service provision found that TARGET antibiotic workshops can help improve antibiotic use, and therefore should be considered as part of any national antimicrobial stewardship initiatives. Additional local facilitation will be needed to encourage all general practices to participate.
Although a success, modifications are required in both packs to further improve student knowledge and make the packs more appealing.
ObjectivesTo explore the knowledge, skills, attitudes and beliefs of general practice staff about C reactive protein (CRP) point-of-care tests (POCTs) in routine general practice and associated barriers and facilitators to implementing it to improve the management of acute cough.DesignA qualitative methodology including interviews and focus groups using the Com-B framework to understand individuals’ behaviour to implement CRP POCT in routine general practice. Data were analysed inductively and then aligned to the Com-B framework.SettingA service evaluation of CRP POCT over a 6-month period was previously conducted in randomly selected GP practices from a high prescribing National Health Service Clinicial Commissioning Groups in England. All 11 intervention practices (eight accepting CRPs; three declining CRPs) and the eight control practices, which were not offered CRP POCT, were also invited to interview. A further randomly selected practice not allocated to intervention or control was also invited to participate.ParticipantsSeven of eight accepting CRP, one of three declining CRP and four of nine control practices consented to participate. 12 practices and 26 general practice staff participated; 11 interviews, 3 focus groups and 1 hand-written response.ResultsParticipants reported that CRP POCT can increase diagnostic certainty for acute cough, inform appropriate management, manage patient expectations for antibiotics, support patient education and improve appropriate antibiotic prescribing. Reported barriers to implementing CRP POCT included: CRP cost, time, easy access to the POCT machine and effects on clinical workflow. Participants with greater CRP use usually had a dedicated staff member with the machine located in their consultation room.ConclusionsCRP POCT can help general practice staff improve patient care and education if incorporated into routine care, but this will need enthusiasts with dedicated POCT instruments or smaller, cheaper, more portable machines. In addition, funding will be needed to support test costs and staff time.
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