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Cardiff study could cut 1.6M ‘unnecessary’ antibiotic prescriptions

09 February 2012

The Stemming the Tide of Antimicrobial Resistance or STAR programme was designed by and implemented by experts from Cardiff University’s School of Medicine’s Institute of Primary Care and Public Health and South East Wales Trials Unit (SEWTU) to cut the number of unnecessary antibiotic prescriptions for common conditions such as acute cough and sinusitis.

Led by Professor Chris Butler, the two-year trial involved 68 practices across Wales covering some 480,000 patients offered GPs access to unique antibiotic prescribing and resistance data derived from their own practices and advanced ‘consulting skills’ tools.

The learning tools, the result of over 15 years of work in infections and communication sciences by members of the Institute of Primary Care and Public Health team, are designed to enable GPs to discuss treatment options more effectively with their patients to better achieve evidence-based, shared and acceptable treatment decisions.

The study gave GPs access to on-line learning materials including videos, and allowed them the flexibility to learn and try out the new skills with their patients at times that were convenient to themselves.

"Antibiotic resistance remains one of the most important public health issues of our time, with antibiotic prescribing driving up resistance," said Professor Butler, who led the study.

"As most antibiotics are prescribed in General Practice, safely reducing the number of unnecessary prescriptions is essential. The STAR programme helped Welsh GPs gain new skills derived from motivational interviewing so they could achieve evidence-based treatment while taking patient perspectives into account.

"Although the percentage reduction in antibiotic prescribing was fairly small, based on national population estimates, if the findings of this study were replicated across the whole of Wales this would imply a reduction of well over 78,000 dispensed oral antibiotic items per year, and if replicated across the UK, a reduction of over 1.6M dispensed oral antibiotic items per year," he added.

The study, published in the British Medical Journal (BMJ), resulted in fewer oral antibiotics for all indications dispensed for a whole year for practices where GPs had undergone STAR training.

Patients in the STAR practices did not experience detectable increases in complications, hospital admissions, re-consultation rates, or costs associated with fewer antibiotics.

Professor Butler adds: "STAR’s achievement in reducing antibiotic prescribing is significant because it has shown signs of success where other efforts such as public health campaigns on antibiotic awareness have failed: despite these campaigns, antibiotic prescribing in the community in the UK appears again to be increasing.

"The STAR intervention goes to the heart of the philosophical foundations of general practice as it is based on patient data from the practices themselves, the best scientific evidence, and effective communication with patients.

"We have shown that fewer oral antibiotics for all indications were dispensed for a whole year for practices where clinicians had undergone STAR training."


Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial was published in the British Medical Journal (BMJ) on the 2nd February (BMJ) BMJ 2012; 344 doi: 10.1136/bmj.d8173

A copy of the paper is available at:

For further information or media interview, please contact:

Professor Chris Butler
Cardiff University
School of Medicine
Institute of Primary Care and Public Health
Tel: 029 20 687168


Chris Jones
Public Relations
Cardiff University
Tel: 029 20 874731

Cardiff University
Cardiff University is recognised in independent government assessments as one of Britain’s leading teaching and research universities and is a member of the Russell Group of the UK’s most research intensive universities. Among its academic staff are two Nobel Laureates, including the winner of the 2007 Nobel Prize for Medicine, University President Professor Sir Martin Evans.

Founded by Royal Charter in 1883, today the University combines impressive modern facilities and a dynamic approach to teaching and research. The University’s breadth of expertise in research and research-led teaching encompasses: the humanities; the natural, physical, health, life and social sciences; engineering and technology; preparation for a wide range of professions; and a longstanding commitment to lifelong learning. Three major new Research Institutes, offering radical new approaches to neurosciences and mental health, cancer stem cells and sustainable places were announced by the University in 2010.