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Stemming the rise of antibiotic resistance to bring improvements for patient care

Professor Alastair Hay is a GP and leading primary care researcher whose career has been supported by the NIHR Academy and NIHR research funding programmes. His work on reducing antibiotic resistance has produced policy-changing results as he investigates the best ways to improve patient care.

Published: 18 May 2023

Research stemming the rise of antibiotic resistance

Antibiotics are the mainstay of treatments for bacterial infections but their overuse has come at a cost, with antibiotic resistance rising and causing at least 700,000 deaths globally each year.

Primary care professionals prescribe around 75% of all antibiotics, and as GP and NIHR-funded researcher Professor Alastair Hay explained: “At the moment, at least half of all antibiotics prescribed in primary care are inappropriate.” Finding ways to reduce antibiotic prescribing and reduce the threat of antibiotic resistance have been longstanding aims of Professor Hay’s career.

Professor Hay is a practicing GP who shares his time between his patients in Bristol and his research post leading the infection research group at the Centre for Academic Primary Care (CAPC): one of the leading centres in the UK which form the NIHR School for Primary Care Research.

Since joining the CAPC in 2001, Professor Hay’s research has been funded by numerous NIHR funding programmes and has produced internationally recognised work on infection management and antibiotic use in primary care. With NIHR’s support, and through collaborative work with other academics around the world, he confirmed the link between antimicrobial resistance and the routine use of antibiotics in primary care.

Influencing guidelines to reduce clinical uncertainty around prescribing

Building on his research experience, in 2009 Professor Hay received a £420,000 NIHR Career Development Fellowship award to supported his investigation into the management of children with respiratory and urinary tract infection in primary care. Awarded by the NIHR Academy, the fellowship supports academics as they develop their careers as leaders in health care.

Following this, Professor Hay was awarded a prestigious NIHR Research Professorship that provided 5-year funding of £1.3 million to investigate ways to reduce the impact of treating children’s respiratory tract infections on NHS resources. Professor Hay said: “The overall aim of this Professorship was to provide evidence that puts the NHS onto a proactive rather than reactive footing in the management of common infectious diseases.”

“The NIHR career development awards enabled me to prioritise the development and support of a growing multidisciplinary team dedicated to tackling a key global health priority.”

Professor Alastair Hay

During this award, Professor Hay’s team developed a tool (STARWAVe) to help primary care practitioners identify serious respiratory infections in children and reduce clinical uncertainty around prescribing antibiotics. Published in The Lancet Respiratory Medicine, STARWAVe accurately predicted which children would benefit from antibiotics. A recently published randomised controlled trial of STARWAVe’s use in general practice showed a small decrease in antibiotic prescribing that could hold promise for some clinical groups (published in the BMJ).

Across his NIHR fellowships, Professor Hay’s research has influenced key changes in primary care practice and made significant contributions to the government’s 2014 goal of reducing antibiotic prescribing by 15% by 2024. For example, his work informed the 2016 NICE Antimicrobial stewardship quality standard, which represented a step change in antibiotic prescribing guidelines for all health professionals and helped reduce antibiotic use by 15% in England between 2017 and 2021.

Professor Hay later joined NICE’s managing common infections committee while his own research also informed NICE guidelines. One of his policy-changing projects was the Diagnosis of urinary tract infection in young children (DUTY) study. His team found that urine dipstick testing allowed GPs to immediately diagnose and treat children between 3 months and 3 years old with a suspected urine infection and the new practice was recommended by 2016 NICE guidance. DUTY’s findings, published in the journal Annals of Family Medicine, also earned the Royal College of General Practitioners Research Paper of the Year award.

Antibiotics are often prescribed to treat young children’s ear infections, despite evidence that they are not needed in most cases. Led by Professor Hay, the Children’s ear pain (CEDAR) study showed that fewer children were prescribed antibiotics if they received painkilling ear drops instead, and the latest NICE guidance on ear infections now recommends this approach.

His team also published evidence in the BMJ that children with fever can be treated with two medicines rather than one. The advice to alternate medicines such as ibuprofen and paracetamol is now reflected in NICE guidance on fever in under 5s.

Recognising and supporting research leaders

Professor Hay’s contributions to primary care and outstanding leadership of patient and people-based research were acknowledged in 2019 when he was appointed as an NIHR Senior Investigator.

“This prestigious award allowed me to support NIHR’s aims, including roles as an NIHR Efficacy and Mechanism Evaluation Programme funding committee member helping to select the very best future research, a mentor for early- and mid-career academics, and an international ambassador giving presentations in Australia and New Zealand.”

Professor Alastair Hay

The following year he was awarded honorary fellowship of the Royal College of Paediatrics and Child Health for his major contributions to paediatrics and child health.

Professor Hay’s current research includes the £1.6 million NIHR-funded project, RAPID-TEST, which is investigating whether same-day tests for respiratory infections in GP surgeries can reduce antibiotic prescribing. “With this work we hope to find an important part of the armoury in the fight against antibiotic resistance. Our collective effort is to find answers that will help patients, doctors, nurses and the NHS achieve the goal of effective antibiotic use,” said Professor Hay.

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