RSV vaccine could reduce antibiotic prescribing - new study

RSV is a viral infection and for most people it leads to mild respiratory symptoms. However, in more vulnerable groups such as babies and older people, it can cause more serious illness and hospitalisation. While antibiotics do not work for viruses, they are sometimes prescribed in primary care as it is often not possible to determine if the infection is bacterial or viral.

The research team examined data from general practice antibiotic prescriptions alongside laboratory-confirmed respiratory infections from 2015 to 2018 with the aim of understanding the proportion of antibiotic prescriptions in English GPs attributable to RSV.

The data, published today as a preprint, shows that approximately 2.1% of antibiotic prescriptions in English GPs were attributable to RSV infections, with the largest number prescribed to those over 75 years old. The highest rate of prescribing was in infants.

A vaccination programme for RSV was launched in September. The vaccine will be offered to those turning 75 on or after 1 September, with a one-off campaign for 2024/25 to vaccinate those aged 75-79 years old. Pregnant women are also offered the vaccine once they reach 28 weeks, with immunity being passed to their newborn. Analysis suggests that there could be 70,000 fewer RSV illnesses in infants under 12 months and 60,000 fewer illnesses in eligible older adults as a result of vaccination.

Dr Lucy Miller, co-author of the study, Modeller at UKHSA, said: “To tackle antibiotic resistance we need to ensure antibiotics are being used only when necessary. But we also need to drive down infections, to reduce the need for antibiotics in the first place.

“This study highlights that the introduction of the new RSV vaccine programme could not only help reduce the risk of infections in vulnerable individuals, but also contribute towards a reduction in antibiotic prescribing and antibiotic resistance in the population overall. At UKHSA we continue to monitor antibiotic prescribing trends and the impact of interventions.”

Professor Céire Costelloe, Visiting Professor of Health Informatics at Imperial College London, and senior author on the study said: “This study provides the first estimate of RSV-attributable primary care antibiotic prescriptions by antibiotic class, using nationally representative primary care and microbiology surveillance data. Importantly, our study suggests that interventions to reduce the burden of RSV infections in England, such as vaccines, could complement current strategies to reduce antibiotic use nationally.”

Dr Angela Hind, Chief Executive of the Medical Research Foundation, said: “Studies like this are vital for highlighting the scale of antibiotic prescribing in England and around the world, which we know is a key driver of antimicrobial resistance in the global population. The new RSV vaccine programme will help us to save antibiotics for the instances where they are most needed.”

Antimicrobial resistance is one of the biggest threats to public health globally, triggered by excessive and inappropriate use which increases the risk of antibiotic resistant bacteria emerging. Earlier this year, the UK’s National Action Plan was launched, aiming to reduce total antibiotic use by 5% by 2029 with the government laying out ambitions and actions that can be taken over the next 5 years.

This study was supported by the NIHR Imperial Biomedical Research Centre (BRC), NIHR Royal Marsden BRC, NIHR Applied Research Collaboration Northwest London, and NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance.

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