Recommendations for research
The guideline committee has made the following recommendations for research to reduce antimicrobial resistance.
What is the cost effectiveness of interventions to prevent infection and promote the appropriate use of antimicrobials?
Lack of studies reporting the costs associated with interventions for either infection prevention or antimicrobial use may act as a barrier to their implementation. Studies with high quality research designs and appropriate cost effectiveness measures are needed to assess this. If research funding bodies ensure cost effectiveness measures are included in research, this will provide the data needed to support the analysis of cost effectiveness.
What is the feasibility and effectiveness of specific behavioural strategies and programmes to reduce inappropriate antimicrobial demand and use and to prevent infections occurring and spreading?
Although the committee has based its recommendations on the best available evidence, little good-quality published evidence was found about the effectiveness of interventions to reduce antimicrobial resistance and prevent the spread of infection. Better quality studies are needed in this area.
What interventions to prevent infection and reduce antimicrobial resistance are effective for groups of people at high risk of infection? This includes people who:
have suppressed immune systems (for example, because of HIV, an inherited condition or treatment they may be having for conditions such as cancer or an organ transplant)
have a chronic disease
live in crowded conditions (see Shelter's definition)
have been in prison
have migrated from countries with a high prevalence of infectious diseases such as tuberculosis (examples include South Asia and sub-Saharan Africa).
Most interventions have not been designed for people at high risk of acquiring or transmitting infectious diseases and antimicrobial-resistant strains. Interventions for these groups have focused on reducing the use of antibiotics for respiratory illnesses. More interventions are needed to address antimicrobial use for other high-risk conditions.
Interventions that effectively improve handwashing and food safety practices and reduce antimicrobial use in low-risk populations cannot be assumed to be effective for high-risk groups. In addition, the lessons learnt from interventions that lead to appropriate use of antimicrobials in low-risk populations cannot necessarily be transferred to high-risk groups.
How effective are interventions in the workplace that aim to prevent infection and reduce antimicrobial resistance?
The workplace is an important setting for helping to prevent the spread of infection among large numbers of people. Information on what works will have a positive impact on the economy by reducing the potential rise in sickness absence caused by the spread of infectious diseases.
More UK randomised control trials are needed in a range of workplace settings.
How effective are interventions in day and residential care for older people that aim to prevent infection and to reduce antimicrobial resistance?
Day and residential care settings for older people are 2 settings where preventing the spread of infection and reducing the risk of antimicrobial resistance are particularly important. This is because many older people are vulnerable to infection as a result of chronic conditions, and there is the risk of infection spreading among large numbers of people. In addition, antimicrobial resistance is increasing in older people, particularly in relation to E. coli infections of the urinary tract.