Final Small Research Grant reports 2018

When Antibiotic Research UK was formed in 2014, one of its objectives was to provide funding support to UK university academics who were researching any aspect of antibiotics and antibiotic resistance. As a small charity, the funds we are able to allocate are limited. To date the charity has had two funding rounds, one in 2018 and one in 2019 – no funding round was called in 2020 owing to the impact of COVID-19 on the charity.

Below are reports provided by the investigators the charity has funded. All grant announcement and awarding procedures followed the guidelines laid down by the Association of Medical Research Charities (AMRC) of which the charity is a member.

2018 Funding Round

Six awards were made in the 2018 funding round, all of which were healthcare related. The total amount of funding was £25,000 and approximately 30 applications were received. Below are the personnel, institution, funding amount and reports from the funded applicants.

1. Royal Veterinary College, University of London: Dr Pablo Alarcon (Grant number ANTSRG 01/2018)

Antibiotic usage on Dairy farms in Great Britain: improving data capture and exploring drivers

Total cost: £3,969

This project explored the accuracy of on-farm antibiotic usage (ABU) records in the dairy industry through completeness and correctness of treatment entries. In addition, recorded use was reconciled with veterinary prescription data where available.

Research showed that recording accuracy was varied across Dairy farms and that on average farmers record 30% less antibiotics than prescribed.In addition, the research identified the key factors on farmers’ perception of the use of a centralised ABU system.

What are the implications of this work?

Accurate and harmonised recording systems on farm level ABU are needed to monitor antibiotic usage, prevent and alert to the development of antibiotic resistance, and to help to identify high-end antibiotic users and target intervention. However, this will require farmers to have software familiarity and IT skills. Results show that the frequent use of paper as a method for record keeping will be a key challenge to this system development. Although study participants indicated a willingness to be transparent with ABU practices, reassurance from industry on the reasons for the need and use of these data, on data security and on its interpretation should be a considered prior to any surveillance system implementation. These findings have been conveyed to the Agriculture and Horticulture Development Board (AHDB), the developers of a data hub for ruminants, and since addressed. This hub has the primary aim of collating national level antibiotic usage data with release scheduled for early 2021. The target is to achieve 95% coverage of dairy farms by 2024.

How will findings from this research be disseminated?

This work will form part of the PhD Thesis conducted by Camilla Strang, to be submitted in March 2021. Thesis title: “Antibiotic usage on UK dairy farms: improving data capture and exploring drivers”. Supervisors: Dr. Lucy Brunton, Dr. Pablo Alarcon Lopez and Dr. Jackie Cardwell.

Two manuscripts from this work are in preparation and will be submitted in Preventive Veterinary Medicine journal this year. Tentative title: “Assessment of antibiotic usage record efficiency in dairy farms and differences with prescription data”; Tentative title of second manuscript: “Dairy farmers’ experiences, perceptions and attitudes towards antibiotic recording system”.


Oral and poster presentation at the International Society for Economics and Social Sciences of Animal Health (ISESSAH) 2020 Conference. Title: “Antibiotic usage in the GB dairy industry: improving data capture and exploring drivers”.
MRF National PhD Training Programme in AMR Conference 2019. Bristol University. Poster Title: “Data capture methods for Antibiotic usage in the UK Dairy Industry: How effective are they?”
ANTRUK presentation. Title: “Antibiotic usage in the GB dairy industry: improving data capture and exploring drivers” (Presenter: Dr. Camilla Strang)
Presentation give to the EIS Research Group at Exeter University. Title: “Antibiotic usage on GB dairy farms: improving data capture and exploring drivers” (Presenter: Dr. Camilla Strang)
A written report to veterinary practices and farmers whom collaborated in the study and requested to hear findings will be conducted this year.

2. Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford: Dr Eric Budgell (Grant number ANTSRG 02/2018)

Impact of hospital antibiotic use on patient-level risk of death among 36,124,372 acute and medical admissions

Total cost: £12,780

Objective: To determine whether initiatives to curb hospital antibiotic use might be associated with harm from under-treatment, the study examined the extent to which variation in hospital antibiotic prescribing is associated with mortality risk in acute/general medicine inpatients.

Setting: 135 acute NHS hospital Trusts in England.

What are the implications of this work?

The study found no evidence that the wide variation in antibiotic use across NHS hospitals is associated with case-mix adjusted mortality risk in acute / general medicine inpatients. Using low-prescribing hospitals as benchmarks could be used to drive safe and substantial reductions in antibiotic consumption of up-to one-third in this population, greatly exceeding the 1% year-on-year reductions required of NHS hospitals.

How will findings from this research be disseminated?

A manuscript is currently under peer review at the Journal of Antimicrobial Chemotherapy (JAC). A draft has been published on MedRxiv at

3. Sheffield Children’s Hospital: Dr Simon Hardman and Prof Alison Condliffe (Grant number ANTSRG 03/2018)

The parental experience of prophylactic antibiotics (PEPPA)

Total cost: £4,000

This study explored parental experiences of having a child prescribed prophylactic antibiotics and how that affects their antibiotic use behaviour. Long-term prophylactic antibiotics are often used to prevent bacterial infections. However, supporting evidence for this is not always robust. Including parents in decisions relating to medication is key to medicines optimisation. Parental concern regarding medication is a major determinant of poor adherence.

The overriding factor influencing parental decisions about the uptake of antibiotic prophylaxis, is wanting their child to be well now. The main concern voiced by parents is that of antibiotic resistance given their children are high users of antibiotics, however this is seen as a problem for the future, not the present.

What are the implications of this work?

A behavioural model is proposed that describes phases parents go through whilst having a child on prophylactic antibiotics. Time invested in holistically addressing the parental experience and having an awareness of potential issues parents face, may facilitate medication adherence, reduce anxieties and improve doctor-parent relationships.

How will findings from this research be disseminated?

The results have been presented to a cohort of parents whose children take prophylactic antibiotics and to local paediatricians. A paper has recently been published in the Archives of Disease in Childhood (Hardman et al, 2020 – Further dissemination of the results is intended in 2021 at the Royal College of Paediatrics and Child Health national conference.

4. St George’s, University of London: Dr Eva Drysdale and Professor Paul Heath (Grant number ANTSRG 04/2018)

Infections causing deaths on UK neonatal units: The ‘Neonatal Antimicrobial Resistance and Outcome (neoAMRO)’ study

Total cost: £4,000

The aim of this project is to understand and describe better those infections and risk factors that lead to neonatal death. Including factors such as whether the wrong antibiotic or wrong dose, are associated with poor outcomes. Such information can then be translated into clinical practice to develop / improve clinical guidance in order to improve outcomes.

Primary Objectives:

To identify the infections leading to death in babies on UK neonatal units.
To define the clinical characteristics of babies dying from infections.
To describe the management of babies dying from infections with a specific focus on their antimicrobial treatment and the antimicrobial resistance profiles of the relevant organisms.

Secondary Objective: To assess the hypothesis that babies who die from bacterial infections on neonatal units do so because they receive inappropriate antibiotic management.

Based on previous neonIN data, we expect to collect data on approximately 800 infants with invasive bacterial infections with around 50 cases of deaths.

Current progress

HRA approval was granted in July 2019 and recruitment commenced in January 2020. Unfortunately, progress has then been very slow through 2020 because most sites have paused non-COVID research. It is hoped that recruitment will start again in 2021.

What are the implications of this work?

It is anticipated that should this study show a clear relationship between the management of specific infections and outcomes for the infants then we will explore which opportunities exist to improve management strategies and provide evidence for national guidelines.

5. London School of Hygiene and Tropical Medicine: Alice Tompson (Grant number ANTSRG 05/2018)

Antibiotic use in cats and dogs: a qualitative study of UK pet owners’ experiences

Total cost: £3,835

This project explored antibiotic use in pets – a topic which has been largely overlooked by initiatives seeking to tackle antibiotic resistance. This is despite twelve million UK households owning pets and classes of antibiotics being shared between human and pet populations.

This study gathered information via observations undertaken in small animal vet clinics and semi-structured interviews. Study objectives were as follows: i) understanding pet owner antibiotic seeking behaviour and ii) the negotiations that take place regarding antibiotic use. In veterinary consultations, owners are usually happy to follow their vet’s proposed treatment plan, including proposed antibiotic use, especially as they are paying for this advice.

Antibiotic resistance is associated with human healthcare or farming and explained in terms of antibiotics no longer working. It is rarely discussed in veterinary consultations. In addition to consulting vets, information sources about pet health include fellow dog walkers, breeders, groomers and the internet.

What are the implications of this work?

Findings suggest that, whilst applying stewardship schemes from human healthcare may be a tempting one health solution, carefully designed pet-specific strategies are needed. Pet owners for example, also have to consider the financial payments required to access veterinary advice, medicines and diagnostic testing. Owners also encounter unique practical challenges when attempting to administer antibiotics to their pets that may affect their ability to complete the course. When prescribing antibiotics, vets and owners should consider the feasibility of their administration and weigh-up the benefits of using antibiotics against the risk of not completing the course. The skills of veterinary nurses could be utilised to demonstrate techniques to help owners deliver medications to non-co-operative pets.

Pet owners use a range of information sources and social networks outside of the vet clinic which could be utilised to raise awareness of antibiotic resistance. For example, leaflets could be included in the information packs distributed at puppy socialisation classes.

How will findings from this research be disseminated?

This fieldwork will form the core of Alice Tompson’s PhD thesis, which was successfully defended in December 2020.


Bloomsbury Colleges PhD Symposium (oral).
Medical Research Foundation National Training Programme in AMR (oral).
Defra Antimicrobial Resistance Coordination Group (oral).
Annual Conference of the Society of Veterinary Epidemiology and Preventative Medicine (oral).


Tompson AC, Chandler CIR, Mateus ALP, O’Neill DG, Chang YM, Brodbelt DC. (2020) What drives antimicrobial prescribing for companion animals? A mixed-methods study of UK veterinary clinics. Prev Vet Med. 183:105117. doi: 10.1016/j.prevetmed.2020.105117.

6. University of Oxford: Dr Oliver Van Hecke (Grant number ANTSRG 06/2018)

Parents’ perceptions of antibiotic use and antibiotic resistance (PAUSE): a qualitative interview study

Total cost: £1,033

Why is this important?

Antibiotic resistance is an important societal health issue. The greatest risk factor for developing a drug-resistant infection is antibiotic use. Almost 75% of all antibiotics in the UK are prescribed in the community where we live. Drug-resistant infections are more difficult to treat, making people more unwell for longer.

Preschool children are at particular risk of receiving unnecessary antibiotics for acute respiratory tract infections (e.g. cough, sore throat, earache) because they commonly see their GP or nurse, and many childhood infections are caused by viruses that do not need antibiotics. Therefore, it is important to understand how parents think about antibiotic resistance as it influences antibiotic use. Such knowledge can inform a bottom-up approach to improve public antibiotic awareness campaigns to help parents better understand the impact of antibiotic use for their families.

What did we do?

We interviewed 23 parents across the greater Thames Valley region during the winter of 2016-17. We explored their perceptions and understanding of antibiotic use and resistance in the context of their young child with a respiratory tract infection and explored the acceptability of new strategies to reduce unnecessary antibiotic consumption.

What did we find?

We found that parents interpreted antibiotic awareness campaigns in a manner where they would not need to change their behaviour. They had a sense of unrealistic optimism and considered their families to be at low risk of antibiotic resistance because their families were “low users” of antibiotics. Very few parents considered antibiotic resistance as a possible harm of antibiotics. Parents wanted future campaigns to have a relevant and accessible message for them about the impact of antibiotic resistance.

What are the implications of this work?

Antibiotic awareness campaigns need to be tailored to reach their intended audience and in a format that they will engage with. This means displaying information quickly, clearly and reliably. Clear and unambiguous terminology is needed to encourage engagement with health messages that have personal relevance for parents and their families.

How will findings from this research be disseminated?


Van Hecke O, Butler CC, Wang K, Tonkin-Crine S. Parents’ perceptions of antibiotic use and antibiotic resistance (PAUSE): a qualitative interview study. J Antimicrob Chemother. 2019 Jun 1;74(6):1741-1747.


National Antimicrobial Resistance and Stewardship Forum 2018, Melbourne (oral)
North American Primary Care Research Group (NAPCRG) 2018, Chicago (oral)
ANTRUK Annual lecture, 24 October 2019, London (poster)