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


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.

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Divisions: ?? 53981500Jl ??
Additional Information: 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. © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Uncontrolled Keywords: 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
Publication ISSN: 1471-2334
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Related URLs: http://www.scop ... tnerID=8YFLogxK (Scopus URL)
https://bmcinfe ... 879-021-05811-7 (Publisher URL)
PURE Output Type: Article
Published Date: 2021-01-22
Accepted Date: 2021-01-15
Authors: Smith, Catherine M.
Shallcross, Laura J.
Dutey-Magni, Peter
Conolly, Anne
Fuller, Christopher
Hill, Suzanne
Jhass, Arnoupe
Marcheselli, Franziska
Michie, Susan
Mindell, Jennifer S.
Ridd, Matthew J.
Tsakos, Georgios
Hayward, Andrew C.
Fragaszy, Ellen B.
Anderson, Niall
Atkins, Lou
Crayton, Elise
Denaxas, Spiros
Elsay, Nadia
Forbes, Gillian
Fragaszy, Ellen
Freemantle, Nick
Gill, Martin
Horne, Rob
Kostkova, Patty
Lorencatto, Fabiana
Richardson, Michelle
Robson, John
Rockenschaub, Patrick
Royston, Claire
Smith, Catherine M.
Sutton, Elizabeth
Thomas, James
Tarrant, Carolyn
Traina, Rosanna
Richardson, Emma (ORCID Profile 0000-0003-0399-2343)
West, Jonathan
Williams, Haydn



Version: Published Version

License: Creative Commons Attribution

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