BA MBCHhB DCH CCH FRCGP FFPH(Hon)
Professor of primary care
University of Oxford
Tell us about your work on antimicrobial resistance?
My qualitative research identifying GPs and patients perspectives on the ‘culture of antibiotic prescribing in primary care’ (Butler BMJ 1998) informed the development of several antimicrobial stewardship trials (Francis BMJ 2009; Cals BMJ 2009; Butler BMJ 2012, 45). My studies have demonstrated: • Reductions in antibiotic prescribing associated with reduced resistance at a GP practice level (Butler • BJGP 2007). • Sputum colour is not associated with meaningful benefit from antibiotics (Butler ERJ 2011) • The four-fold unwarranted variation in antibiotic prescribing our 13-country, 3402 patient study was not explained by case mix, and that antibiotics made no difference to patient outcome, allowing care to be standardized and refocused (Butler BMJ 2009) • Training in advanced communication skills (that I developed) and use of a point of care biomarker, CRP, resulted in dramatic and safe reductions in antibiotic prescribing for cough (Cals BMJ 2009), confirmed in our six-country study of Internet communication skills training and CRP use (Little Lancet 2013) • Nurse practitioner care for same day appointment can be comparable to GP care (Kinnersley BMJ 2000) • Fewer tests are needed for managing uncomplicated Urinary Tract Infection (Butler BJGP 2015) • Antibiotic resistant urinary tract infections are symptomatic for longer and increased GP workload (Butler BJGP 2006). • The public commonly regards antimicrobial resistance as a property of their own bodies, rather than of bacteria (Brookes-Howell J Gen Int Med 2012) • GP practices that reduced their antibiotic prescribing the most submitted urine samples with the greatest reductions in resistant organisms (Butler BJGP 2007)
How does your work make things better for patients?
What are the best 3 things you've seen in Primary Healthcare to combat antimicrobial resistance?
1. Enhanced communication skills training for GPs. 2. More narrow spectrum antibiotic use. 3. More self care for common infections