As the global health community marks World AMR Awareness Week, the focus shifts to the "silent pandemic" of antimicrobial resistance (AMR).

While hospital superbugs often grab the headlines, the frontline of this battle is actually in the community. With the majority of antibiotics prescribed in primary care settings, general practice is where the fight to preserve effective medicine will be won or lost.

At the Nuffield Department of Primary Care Health Sciences, our researchers are leading a multi-pronged strategy to address this threat. By combining cutting-edge diagnostic trials with behavioural science and large-scale European collaboration, we are working to ensure antibiotics remain effective for generations to come.

The diagnostic dilemma: guessing games vs precision

One of the primary drivers of resistance is the lack of rapid, accurate information at the point of care. GPs often have to make prescribing decisions based on symptoms alone, without knowing exactly which bacteria – if any – is causing the infection.

Take urinary tract infections (UTIs), for example. Half of all women will experience a UTI in their lifetime, yet GPs currently lack rapid tests to confirm infection or identify the effective antibiotic. This leads to precautionary prescribing, fuelling resistance.

The TOUCAN study has tackled this head-on. This project – now finished recruiting and reporting on its results soon – evaluated new rapid diagnostic devices in GP surgeries that could offer results in just 40 minutes. If accurate, these tools could revolutionise care, giving doctors and patients the confidence to make immediate, appropriate treatment decisions without relying on slower laboratory tests.

Similarly, the PRUDENCE trial – also due to report soon – has been evaluating point-of-care testing for respiratory tract infections (RTIs). The aim is to reduce antibiotic prescribing safely, ensuring that withholding a prescription doesn't compromise a patient's recovery.

Putting patients at the heart of the solution

Technology alone is not the answer; we also need to understand what patients and clinicians need. This is evident in our work on cellulitis, a common skin infection where misdiagnosis is frequent.

Through the NIHR HealthTech Research Centre in Community Healthcare, our researchers are running a project to define what an "ideal" cellulitis test should look like. By working directly with patients, carers, and clinicians, we are ensuring that future diagnostic tools address real-world anxieties about recovery and recurrence, rather than relying on assumptions.

The "Goldilocks" question: how long is long enough?

Even when antibiotics are necessary, we often don't know the optimal length of treatment. Taking antibiotics for too long drives resistance, but stopping too soon risks relapse.

The DURATION trial is a landmark study seeking to answer this question for UTIs. By randomising people to different treatment lengths and monitoring them for 42 days, researchers aim to find the shortest effective course. This study also includes a vital sub-study looking at how treatment duration impacts resistance in gut bacteria – a key reservoir for resistant microbes.

Pandemic preparedness and international collaboration

Infectious diseases do not respect borders. The Department is a key partner in ECRAID (European Clinical Research Alliance on Infectious Diseases), a pan-European network designed to ensure we are ready for the next public health threat.

Through ECRAID-Base, we are participating in ‘perpetual observational studies’ that act as a ‘warm base’ for research. This infrastructure allows us to rapidly pivot to clinical trials when needed. For instance, the POS-ARI-PC study within ECRAID-Base is currently monitoring acute respiratory infections across Europe, establishing a research-ready infrastructure that can ‘plug in’ new studies during epidemics. Simultaneously, ECRAID-Prime is investigating treatments for respiratory infections in the community to speed up recovery and prevent hospital admissions.

This focus on respiratory health is reinforced through the Department hosted Centre for Applied Respiratory Research, Innovation and Impact (CARRii), which is transforming respiratory care across the UK and tackling the winter pressures that often lead to precautionary antibiotic prescribing.

A transdisciplinary approach

Better infection management requires changes by both healthcare professionals and patients. This is where the Behaviour, Implementation Science and Qualitative methods in Infections research Team (BISQIT) plays a pivotal role.

Behavioural science underpins all our research, ensuring that we don't just develop new tests or treatments, but understand the barriers to using them in the real world. The BISQIT team collaborates across our major trials – including PRUDENCE and ECRAID – to identify the human factors that influence prescribing. By understanding the pressures on clinicians and the experiences of patients, they help design interventions that empower self-management and support prudent antibiotic use.

This work extends into policy through our links with the NIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infections and Antimicrobial Resistance. Here, our researchers lead themes on advancing stewardship and establishing the population impact of resistance.

This week, we will be highlighting three specific initiatives that demonstrate how we are widening the scope of AMR research:

• The PEOPLE AMR Network: As one of eight transdisciplinary networks funded by UKRI's Tackling Infections Initiative, this group brings together researchers from diverse fields to design interventions that account for human behaviour.
• The SPARROW Project: We will be looking ahead to the upcoming launch of this ambitious new initiative, which investigates innovative approaches to reducing antibiotic use through better testing and decision support.
• Policy in Action: Demonstrating how our researchers are taking evidence directly to government, we will be sharing details of Dr Abi McNiven’s recent presentation of evidence to the All-Party Parliamentary Group (APPG) on AMR.

Looking ahead

As AMR threatens to make routine surgeries risky and common infections deadly, the work emerging from Oxford's primary care researchers offers concrete solutions. From rapid diagnostics that could transform prescribing decisions within minutes, to international research networks that ensure we're ready for the next pandemic, this research demonstrates that primary care isn't just where most antibiotics are prescribed – it's where the solution to AMR will be found.