How Real-World Evidence in Wales Is Empowering Informed Antibiotic Use

Antimicrobial resistance (AMR) is one of the most pressing global health threats. As bacteria become resistant to antibiotics, infections that were once easily treated can become harder, and sometimes impossible, to cure.

Most antibiotics are prescribed in primary care, for problems such as coughs, chest infections and flare-ups of chronic lung conditions such as COPD. Many of these infections are caused by viruses, so antibiotics will not help recovery. Unnecessary antibiotic use can cause side effects and crucially drives the rise of resistance.

So, how can we make antibiotic prescribing more targeted and evidence based?

Testing smarter: a promising tool for primary care

One promising approach is implementing C-reactive protein (CRP) point-of-care tests (POCT). This simple finger-prick blood test gives results within minutes and can help clinicians decide whether antibiotics are likely to help their patient.

Clinical trials show CRP POCTs can help safely reduce antibiotic prescribing for lower respiratory tract infections (LRTIs) and COPD exacerbations. NICE recommends their use when clinicians are unsure whether antibiotics are needed. But CRP POCTs are not yet widely used in routine NHS practice. So, we need more real-world evidence about how to integrate them into everyday care.

A unique opportunity to study real-world practice

The SPARROW study (Supporting Prudent Antibiotic use with CRP Point-of-CaRe testing fOr LRTIs in Wales), led by the University of Oxford in partnership with Welsh Health Boards, is addressing this gap. As many practices across Wales begin introducing CRP POCTs through a national rollout, SPARROW has a rare chance to observe how testing is actually used across a national health system and to identify what helps, and what hinders adoption.

What is SPARROW doing?

SPARROW will explore not only the impact of CRP POCTs on prescribing but also the process of embedding tests in everyday clinical practice and how that process can be optimised.

Phase 1: Evaluating implementation
The study team will observe how general practices and pharmacies adopt CRP POCTs, collect clinician feedback and analyse anonymised practice data through the SAIL Databank to understand changes in antibiotic prescribing and patient outcomes.

Phase 2: Optimising impact
Using insights from Phase 1, the team will co-design and trial different approaches to encourage appropriate test use to inform antibiotic prescribing. This may include behaviour change support and incentive models. A range of general practices and pharmacies will take part, allowing comparisons across sites to evaluate feasibility, effectiveness and cost-effectiveness.

Informing action locally and beyond

By studying how CRP POCTs are used in real-world practice, the SPARROW study will generate valuable evidence on how to implement these tools sustainably and effectively. The findings will inform policy and clinical practice in Wales and offer lessons for other health systems aiming to strengthen antibiotic stewardship in primary care.

Our work ties closely to this year’s World Antimicrobial Resistance Awareness Week theme, “Act Now: Protect Our Present, Secure Our Future”. Community point of care testing is a practical step towards that goal, helping clinicians make prudent prescribing decisions today so antibiotics can remain effective tomorrow.

Learn more

We’re keen to connect with anyone interested in supporting informed antibiotic use, whether you’re a policymaker, clinician, researcher, or member of the public.

Email clare.clement@phc.ox.ac.uk to learn more or share your thoughts and follow our updates on the Department’s website and communications channel.