Incidence, healthcare-seeking behaviours, antibiotic use and natural history of common infection syndromes in England: results from the Bug Watch community cohort study

Catherine M. Smith, Laura J. Shallcross, Peter Dutey-Magni, Anne Conolly, Christopher Fuller, Suzanne Hill, Arnoupe Jhass, Franziska Marcheselli, Susan Michie, Jennifer S. Mindell, Matthew J. Ridd, Georgios Tsakos, Andrew C. Hayward, Ellen B. Fragaszy, Niall Anderson, Lou Atkins, Elise Crayton, Spiros Denaxas, Nadia Elsay, Gillian ForbesEllen Fragaszy, Nick Freemantle, Martin Gill, Rob Horne, Patty Kostkova, Fabiana Lorencatto, Michelle Richardson, John Robson, Patrick Rockenschaub, Claire Royston, Catherine M. Smith, Elizabeth Sutton, James Thomas, Carolyn Tarrant, Rosanna Traina, Emma Richardson, Jonathan West, Haydn Williams

    Research output: Contribution to journalArticlepeer-review


    Background: Better information on the typical course and management of acute common infections in the community could inform antibiotic stewardship campaigns. We aimed to investigate the incidence, management, and natural history of a range of infection syndromes (respiratory, gastrointestinal, mouth/dental, skin/soft tissue, urinary tract, and eye). Methods: Bug Watch was an online prospective community cohort study of the general population in England (2018–2019) with weekly symptom reporting for 6 months. We combined symptom reports into infection syndromes, calculated incidence rates, described the proportion leading to healthcare-seeking behaviours and antibiotic use, and estimated duration and severity. Results: The cohort comprised 873 individuals with 23,111 person-weeks follow-up. The mean age was 54 years and 528 (60%) were female. We identified 1422 infection syndromes, comprising 40,590 symptom reports. The incidence of respiratory tract infection syndromes was two per person year; for all other categories it was less than one. 194/1422 (14%) syndromes led to GP (or dentist) consultation and 136/1422 (10%) to antibiotic use. Symptoms usually resolved within a week and the third day was the most severe. Conclusions: Most people reported managing their symptoms without medical consultation. Interventions encouraging safe self-management across a range of acute infection syndromes could decrease pressure on primary healthcare services and support targets for reducing antibiotic prescribing.

    Original languageEnglish
    Article number105
    JournalBMC Infectious Diseases
    Issue number1
    Publication statusPublished - 22 Jan 2021

    Bibliographical note

    Funding Information:
    This work is supported by the Economic and Social Research Council, grant number ES/P008321/1, as part of the Preserving Antibiotics through Safe Stewardship (PASS) project. Professor Hayward is a National Institute for Health Research (NIHR) Senior Investigator. MJR is funded by an NIHR Post-Doctoral Research Fellowship (PDF-2014 − 07-013). LS is funded by a NIHR Clinician Scientist Award (CS-2016-16-007). AJ is funded as an NIHR In-Practice Fellow.

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    • Anti-Bacterial Agents/therapeutic use
    • Antimicrobial Stewardship
    • Cohort Studies
    • Delivery of Health Care
    • England/epidemiology
    • Female
    • Humans
    • Incidence
    • Infections/drug therapy
    • Male
    • Middle Aged
    • Referral and Consultation/statistics & numerical data
    • Surveys and Questionnaires
    • Syndrome


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