Leaflets promoting antimicrobial stewardship help reduce patient escalation, study finds

Community pharmacy teams have helped reduce patient escalations and promote antimicrobial stewardship through widespread use of the TARGET 'Treating Your Infection' (TYI) respiratory tract infection (RTI) leaflets, according to a newly published report in the journal JAC – Antimicrobial Resistance.

The study assessed the impact of the AMS quality criterion in the 2022/23 and 2023/24 Pharmacy Quality Scheme (PQS), which required participating pharmacies to use TYI leaflets with patients presenting with suspected upper RTIs.

Across the two years, 225,615 patients were reviewed using the leaflets. A total of 7,525 pharmacies took part in at least one year, with 7,407 involved in both.

The data show a reduction in the proportion of patients requiring escalation to a pharmacist – down from 23% in 2022/23 to 15% in 2023/24. Around one in three patients were managed entirely by the wider pharmacy team.

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The study also found a drop in signposting to other healthcare providers (from 12% to 7%) and a reduction in immediate escalations (from 6% to 4%).

Most patients were offered over-the-counter medicines – 85% in 2022/23 and 89% in 2023/24 – while self-care advice was provided to 95% of patients in 2022/23 and 97% in 2023/24. About one-third received additional written information in both years.

The study concluded: 'The TARGET TYI-RTI leaflets have aided in England’s community pharmacies counselling and educating patients about their symptoms, helping to safety-net and reassure patients, as well as escalate where appropriate. This in turn can help with reducing inappropriate GP appointments and hospital admissions, and prevent the inappropriate use of emergency departments. The use of incentivization via the PQS has allowed significant clinical progress in and awareness of AMS to be made at pace for all of England’s community pharmacies. It is not clear if such progress could be achieved in any other way.'

The publishing of the study results follows the release of the latest UK Health Security Agency (UKHSA) English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report, which showed that an antimicrobial was supplied in 45% to 85% of Pharmacy First consultations between April 2024 and March 2025.

According to the report, uncomplicated urinary tract infections (UTIs) were the most likely condition to be treated with an antimicrobial, with 85% of consultations resulting in one being supplied. An antimicrobial was supplied in 82% of shingles consultations and 83% of infected insect bite consultations.

Antimicrobial supply was lowest for patients with acute otitis media (45%) and acute sinusitis (47%), while more than 60% of consultations resulted in the supply of an antimicrobial for acute sore throat (65%) and impetigo (68%).

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The English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report also revealed that almost 400 new cases of antibiotic-resistant infections were reported each week in England last year.

The data show that 20,484 cases of resistant bacteraemia, where bacteria enter the bloodstream, were recorded in 2024, representing a 9.3% increase on the previous year.

The number of deaths linked to resistant infections also increased, from 2,041 in 2023 to 2,379 in 2024.

UKHSA recently relaunched its mascot Andi Biotic, with a new campaign aimed at young adults.

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The red and white pill character was first introduced in April 2025 as part of UKHSA’s Keep Antibiotics Working campaign.

The relaunch aims to build on that messaging, using humour and visual storytelling to raise awareness of responsible antibiotic use in everyday settings.