New analysis by researchers at Oxford Population Health, Imperial College London, and the UK Health Security Agency (UKHSA) has found that respiratory syncytial virus (RSV) infections lead to 640,000 antibiotic prescriptions a year. The study highlights that interventions to reduce RSV infections, including the new UK vaccination programme, could help reduce antibiotic prescribing and therefore antibiotic resistance.
The study, published as a preprint, was funded by the Medical Research Foundation and National Institute for Health and Care Research (NIHR).
RSV is a viral infection and for most people it leads to mild respiratory symptoms. However, in more vulnerable groups such as babies and older people, it can cause more serious illness and hospitalisation. While antibiotics do not work for viruses, they are sometimes prescribed in primary care as it is often not possible to determine if the infection is bacterial or viral.
The research team examined data from general practice antibiotic prescriptions alongside laboratory-confirmed respiratory infections from 2015 to 2018 with the aim of understanding the proportion of antibiotic prescriptions made in English general practices attributable to RSV.
The data shows that approximately 2.1% of antibiotic prescriptions were attributable to RSV infections, with the largest number prescribed to those over 75 years old. The highest rate of prescribing was in infants.
A vaccination programme for RSV was launched in September. The vaccine is being offered to those turning 75 on or after 1 September, with a one-off campaign for 2024/25 to vaccinate those aged 75-79 years old. Pregnant women are also offered the vaccine once they reach 28 weeks, with immunity being passed to their newborn. Analysis suggests that there could be 70,000 fewer RSV illnesses in infants under 12 months and 60,000 fewer illnesses in eligible older adults as a result of vaccination.
Dr Lucy Miller, co-author of the study and Modeller at UKHSA, said ‘To tackle antibiotic resistance we need to ensure antibiotics are being used only when necessary. But we also need to drive down infections, to reduce the need for antibiotics in the first place. This study highlights that the introduction of the new RSV vaccine programme could not only help reduce the risk of infections in vulnerable individuals, but also contribute towards a reduction in antibiotic prescribing and antibiotic resistance in the population overall. At UKHSA we continue to monitor antibiotic prescribing trends and the impact of interventions.’
Dr Koen Pouwels, Associate Professor at Oxford Population Health’s Health Economics Research Centre, said ‘Antimicrobial resistance is one of the biggest threats to public health globally, triggered by unnecessary antibiotic use which increases the development and spread of antibiotic resistance. Our study suggests that infection prevention strategies such as RSV vaccination programmes could complement national efforts to reduce antibiotic use and thereby reduce the threat of antimicrobial resistance.’
Professor Céire Costelloe, Visiting Professor of Health Informatics at Imperial College London, and senior author on the study, added ‘This study provides the first estimate of RSV-attributable primary care antibiotic prescriptions by antibiotic class, using nationally representative primary care and microbiology surveillance data. Importantly, our study suggests that interventions to reduce the burden of RSV infections in England, such as vaccines, could complement current strategies to reduce antibiotic use nationally.’
Dr Angela Hind, Chief Executive of the Medical Research Foundation, said ‘Studies like this are vital for highlighting the scale of antibiotic prescribing in England and around the world, which we know is a key driver of antimicrobial resistance in the global population. The new RSV vaccine programme will help us to save antibiotics for the instances where they are most needed.’
This study was supported by the NIHR Imperial Biomedical Research Centre (BRC), NIHR Royal Marsden BRC, NIHR Applied Research Collaboration Northwest London, and NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance