Antibiotic Review Kit (ARK)-Hospital
A fuller technical discussion of the ARK-Hospital programme and the National CQUIN for ‘Antimicrobial resistance and Antimicrobial Stewardship’ is available here
Antibiotic Reduction and Konservation (ARK) in Hospitals (ARK-Hospital) is a research programme aiming to safely reduce antibiotic use in hospitals. Antibiotics are essential to treat serious infections caused by bacteria. Unfortunately, the more bacteria are exposed to antibiotics, the more likely they are to become resistant. This means that antibiotics stop working. So it is important that antibiotics are only used when they are needed.
Whilst antibiotics kill bacteria, they don’t cure viral infections. When sick patients arrive at hospital, doctors have to try to work out whether they have a bacterial infection, viral infection, or another illness altogether. This is difficult, because initially the symptoms can be very similar (e.g. cough, temperature).
Finding out exactly why a patient is sick takes a while, so it makes sense to give antibiotics initially. However, Department of Health guidance recommends stopping antibiotics when it becomes clear that they aren’t needed anymore. This could be because doctors work out that the patient never had a bacterial infection, or because they have got better. Stopping antibiotics when they aren’t needed reduces the chances of disease-causing and other gut bacteria becoming resistant to antibiotics. It is also important because antibiotics kill ‘friendly’ gut bacteria.
However, stopping antibiotics when they are no longer needed often doesn’t happen. Sometimes this is ‘just in case’ or thinking ‘better safe than sorry’, or because of the myth that antibiotic courses must be completed to avoid resistance. But, because gut bacteria, rather than those causing disease, become antibiotic-resistant during treatment, taking more antibiotics than really needed is not a safe strategy for the future.
There is no good evidence on how best to encourage doctors to stop giving unnecessary antibiotics in hospitals and changing behaviour is hard. This research will first summarise findings from previous studies of strategies for using fewer antibiotics to make sure this is safe. We will also analyse existing hospital data to check that there is no other evidence that stopping antibiotics could harm patients. We will then ask patients, their relatives and healthcare workers what they think about stopping antibiotics. We will use all this information to develop a package of strategies to help doctors, nurses, pharmacists and patients stop antibiotics in hospital when they are no longer needed. The package is likely to include internet-based education, training, standard systems to help doctors review patients, regular support from pharmacists or infections specialists, and materials for patients themselves. We will test the package in 36 hospitals, comparing what happens before and after its introduction. We aim to reduce overall exposure to antibiotics by >15%. We will assess if patients’ health is affected at all, to make sure this can be done safely.
This programme is funded by an NIHR-Programme grant. It is a collaboration between doctors and researchers from primary care (GPs), hospitals and universities across Southern England. The research team have experience in this area, and include NHS doctors, health psychologists, behaviour change experts, statisticians/clinical trial specialists, health economists, pharmacists and patient representatives.
The research is funded by NIHR Programme Grants for Applied Research RP-PG-0514-20015. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health