Usher Institute

Usher researchers lead on £2.5 million grant to support appropriate antibiotic prescribing

Professor Aziz Sheikh is leading a major new initiative to develop and evaluate an improvement to existing hospital electronic prescribing systems to tackle antibiotic over-prescribing in the UK.

Working with Professor Jamie Coleman of the University Hospitals Birmingham NHS Foundations Trust, the team from the Usher Institute will develop a system to support new ways of working designed to safely reduce inappropriate antibiotic prescribing.

Antibiotic over-prescribing

Increasingly, bacteria (germs) no longer respond to antibiotics. This means antibiotics have begun to stop working as well as they should. This can result in patients experiencing more severe infections, lasting longer than they previously did, and may, in some cases, lead to an increased risk of dying from infections.

This is due to too much inappropriate use of antibiotics. The UK Government and World Health Organization believe this is an extremely important issue to tackle.

The reasons for overuse of antibiotics include doctors not having relevant information (e.g. on resistance patterns) when prescribing antibiotics, concerns about missing possibly serious infections, and time pressures/lack of continuity of care, limiting opportunities for doctors to review diagnoses and stop antibiotics if no longer needed.

The team will build on their recently completed NIHR-funded research, which developed an ePrescribing Toolkit. This has promoted the use of hospital ePrescribing systems across NHS England. As ePrescribing systems become more widely available, the team want to see if they can be used to safely reduce antibiotic prescribing with no change in mortality.

Antibiotic resistance is now a major global concern.   Reducing inappropriate prescribing of antibiotics will help to minimise the development of antibiotic resistance, saving lives. This is however a complex challenge as clinicians often need to grapple with considerable clinical uncertainty.  We are delighted to have received funding to develop a new electronic system and associated training programme designed to support busy frontline healthcare professionals in making evidence-based decisions in relation to the starting, switching and stopping of antibiotics.  Once developed, we plan to then undertake a trial to evaluate the safety and effectiveness of this new approach.

Professor Aziz SheikhDirector of Usher Institute and Principal Investigator


Over the next 5 years, the team aim to develop and evaluate a multifaceted intervention (ePAMS+) that incorporates technical, behavioural and organisational components to safely reduce inappropriate antibiotic use in adult medical in-patients.

The first step will be to carefully plan all the elements a new intervention (ePAMS+) needs to help hospitals prescribe antibiotics appropriately.

It is anticipated that ePAMS+ will incorporate two closely related parts:

  1. a training package, clinical team processes and patient leaflet to help everyone involved understand the importance of reducing antibiotic use and how this can be done safely and effectively;
  2. an online computer software system that works with the existing ePrescribing system, gathering information relevant to making antibiotic prescribing decisions, presenting this to clinicians at the time and in the format it is needed, and monitoring/providing feedback to clinical teams on the appropriateness of their antibiotic use.

The team will investigate how best to deliver ePAMS+ to hospitals by testing it on a small scale before undertaking a larger study. This will allow them to measure the clinical effects of ePAMS+ on antibiotic use and assess whether ePAMS+ is a good use of NHS resources.

Funding and collaboration

Funding has been received from the National Institute for Health Research (NIHR) Programme Grants for Applied Research.

The collaboration includes the Universities of Edinburgh, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Royal Free London NHS Foundation Trust, NHS England, University of Bristol, University of Birmingham, Newcastle University, University of Warwick, Brigham and Women's Hospital.

Further information

Professor Aziz Sheikh’s profile

ePrescribing Toolkit website

ePAMS website