WP3: Infections & Antimicrobial Resistance

In this work package we build on our international reputation for conducting research on the management of infections, antimicrobial stewardship, and antimicrobial resistance. The widespread use of antibiotics in primary care contributes to the development of antimicrobial resistance, widely described as one of the most serious threats of our times.

We aim to maximise the understanding of infectious disease epidemiology and mechanisms, develop and evaluate interventions to improve management of common infections and enhance antimicrobial stewardship in primary care.

The results of our research will impact on clinical practice and health care policy for the benefit of patients, clinicians and communities of Wales and beyond.

Core activities

  • Lead and facilitate successful primary care infection research funding proposals that are of high quality and value, and multi-disciplinary.
  • Continue to build collaborations and involve users to identify and prioritise our research ensuring that this is consistent with Welsh primary health care policy priorities and HCRW objectives.
  • Increase the research evidence-base for primary care infection and antimicrobial resistance, and impact on clinical practice and primary health care policy through translation, training and dissemination.
  • Lead, support and ensure the delivery of existing, and future research projects.
  • Maintain and develop strong academic leadership from within the primary care research community in Wales, and continue to build research capacity.


Dr Nick Francis, Cardiff University

Current projects

  1. ARTIC PC - Antibiotics for lower Respiratory Tract Infection in Children presenting in Primary Care
  2. CEDAR - Children's drops for ear pain in acute otitis media
  3. Investigating the prodrome of Type 1 diabetes in childhood using SAIL and Brecon Group data
  4. Morbidity following urinary tract infection in young children
  5. PRINCESS - Evaluating the efficacy of probiotics in reducing antibiotic administration for infection in care home residents


Time to resolution and effect on quality of life of molluscum contagiosum in children in the UK: a prospective community cohort study. Olsen JR, Gallacher J, Finlay AY, Piguet V, & Francis NA. (2015a). The Lancet Infectious Diseases, 15(2), 190–195. 

Understanding flucloxacillin prescribing trends and treatment non-response in UK primary care: a Clinical Practice Research Datalink (CPRD) study. Francis NA, Hood K, Lyons R & Butler CC.  J. Antimicrob. Chemother. (2016) doi: 10.1093/jac/dkw084 

A randomised placebo-controlled trial of oral and topical antibiotics for children with clinically infected eczema in the community: the ChildRen with Eczema, Antibiotic Management (CREAM) study. Francis NA, Ridd MJ, Thomas-Jones E, Shepherd V, Butler CC, Hood K, Huang C, Addison K, Longo M, Marwick C, Wootton M, Howe R, Roberts A, Haq M, Madhok V, Sullivan F. Health Technol Assess. 2016 Mar;20(19):1-84. doi: 10.3310/hta20190.

Quality of Life impact of childhood skin conditions measured using the Children's Dermatology Life Quality Index (CDLQI): a meta-analysis. Olsen JR, Gallacher J, Finlay AY, Piguet V, & Francis NA. (2015). The British Journal of Dermatology.  

Discrepancies between qualitative and quantitative evaluation of randomised controlled trial results: achieving clarity through mixed methods triangulation. Tonkin-Crine S, Anthierens S, Hood K, Yardley 4, Cals JW, Francis NA, Coenen S, van der Velden AW, Godycki-Cwirko M, Llor C, Butler CC, Verheij T, Goossens H, Little P; GRACE INTRO/CHAMP consortium. Implement Sci. 2016 May 12;11(1):66. doi: 10.1186/s13012-016-0436-0. 

Antibiotic prescribing and associated diarrhoea: a prospective cohort study of care home residents. Gillespie D, Hood K, Bayer A, Carter B, Duncan D, Espinasse A, Evans M, Nuttall J, Stanton H, Acharjya A, Allen S, Cohen D, Groves S, Francis N, Howe R, Johansen A, Mantzourani E, Thomas-Jones E, Toghill A, Wood F, Wigglesworth N, Wootton M, Butler CC. Age Ageing. 2015 Sep;44(5):853-60. doi: 10.1093/ageing/afv072. 

Clinicians' views and experiences of interventions to enhance the quality of antibiotic prescribing for acute respiratory tract infections.  J Gen Intern Med, Volume 30, 4 April 2015 pp.408-416 Anthierens S, Tonkin-Crine S, Cals JW, Coenen S, Yardley L, Brookes-Howell L, Fernandez-Vandellos P, Krawczyk J, Godycki-Cwirko M, Llor C, Butler CC, Verheij T, Goossens H, Little P, Francis NA, GRACE/CHAMP INTRO team 

Analytic laboratory performance of a point of care urine culture kit for diagnosis and antibiotic susceptibility testing. E Bongard, N Frimodt-Møller, M Gal, M Wootton, R Howe, N Francis, H Goossens, CC Butler. European Journal of Clinical Microbiology & Infectious Diseases. October 2015, Volume 34, Issue 10, pp 2111-2119

Molluscum contagiosum and associations with atopic eczema in children: a retrospective longitudinal study in primary care. Olsen JR, Piguet V, Gallacher J, & Francis NA. (2015b). The British Journal of General Practice: the Journal of the Royal College of General Practitioners, 66(642), e53–e58. 

Dental consultations in UK general practice and antibiotic prescribing rates: a retrospective cohort study. Cope A, Chestnutt IG, Wood F, Francis NA. British Journal of General Practice. Br J Gen Pract. 2016 May;66(646):e329-36. doi: 10.3399/bjgp16X684757. 

General Practitioners’ attitudes towards the management of dental conditions and use of antibiotics in these consultations: a qualitative study. Cope A.L., Wood F., Francis N.A. and Chestnutt, I.G (2105) British Medical Journal Open 5:e008551 

Bath additives for the treatment of childhood eczema (BATHE): protocol for multicentre parallel group randomised trial. Santer M, Rumsby K, Ridd M, Francis NA, Stuart B, Chorozoglou M, Wood W, Roberts A, Thomas KS, Williams HC, Little P. BMJ Open. 2015 Nov 1;5(10):e009575. doi: 10.1136/bmjopen-2015-009575.

The CHICO (Children's Cough) Trial protocol: a feasibility randomised controlled trial investigating the clinical and cost-effectiveness of a complex intervention to improve the management of children presenting to primary care with acute respiratory tract infection. Turnbull SL, Redmond NM, Lucas P, Cabral C, Ingram J, Hollinghurst S, Hay AD, Peters TJ, Horwood J, Little P, Francis N, Blair PS. BMJ Open 2015;5:e008615 doi:10.1136/bmjopen-2015-008615

Illness perception and related behaviour in lower respiratory tract infections-a European study. Hordijk PM, Broekhuizen BD, Butler CC, Coenen S, Godycki-Cwirko M, Goossens H, Hood K, Smith R, van Vugt SF, Little P, Verheij TJ, GRACE Project Group, Fam Pract, Volume 32, 2 April 2015 pp.152-158 

Parental views on childhood vaccination against viral gastroenteritis—a qualitative interview study. Fiona V Lugg, Christopher C Butler, Meirion R Evans, Fiona Wood, Nick A Francis. Family Practice, 2015, 1–6. doi:10.1093/fampra/cmv035

Parental perceptions and understanding of information provision, management options and factors influencing the decision-making process in the treatment of children with glue ear. Gkiousias V, Butler CC, Shepherd V, Kilgour JM, Waldron C-A, Thomas-Jones E, Francis N. Int J Pediatr Otorhinolaryngol. Elsevier; 2016 Oct;89:6–12.  

How do general practitioners implement decision-making regarding COPD patients with exacerbations? An international focus group study. Laue J, Melbye H, Halvorsen P, Andreeva E, Godycki-Cwirko M, Wollny A, Francis NA, Spigt M, Kung K, Risør MB. Int J Chron Obstruct Pulmon Dis. 2016;Volume 11:3109–19. 

An illness-focused interactive booklet to optimise management and medication for childhood fever and infections in out-of-hours primary care: study protocol for a cluster randomised trial. de Bont EGPM, Dinant G-J, Elshout G, van Well G, Francis NA, Winkens B, et al. Trials. BioMed Central; 2016 Nov 17;17(1):547.  

Oral and Topical Antibiotics for Clinically Infected Eczema in Children: A Pragmatic Randomized Controlled Trial in Ambulatory Care. Francis NA, Ridd MJ, Thomas-Jones E, Butler CC, Hood K, Shepherd V, Marwick CA, Huang C, Longo M, Wootton M, Sullivan F, the CREAM Trial Management Group. Ann Fam Med 2017;15:124-130. https://doi.org/10.1370/afm.2038. 

Oral steroids for the resolution of otitis media with effusion (OME) in children (OSTRICH): study protocol for a randomised controlled trial. Waldron CA, Thomas-Jones E, Cannings-John R, Hood K, Powell C, Roberts A, Tomkinson A, Fitzsimmons D, Gal M, Harris D, Shepherd V, Butler CC, Francis N. Trials. 2016 Mar 1;17(1):115. doi: 10.1186/s13063-016-1236-1. 

The Management of Acne Vulgaris in Primary Care: A cohort study of consulting and prescribing patterns using CPRD. Francis NA, Entwistle K, Santer M, Layton AM, Eady EA, Butler CC.Br J Dermatol, 176: 107–115. doi:10.1111/bjd.15081 

Clinicians’ interpretations of point of care urine culture vs laboratory culture results: analysis from the four-country POETIC trial of diagnosis of uncomplicated urinary tract infection in primary care. S. Hullegie, M. Wootton, T.J.M. Verheij, E. Thomas-Jones, J Bates, K Hood, M Gal, NA Francis, P. Little, M. Moore, C. Llor, T. Pickles, D. Gillespie, N. Kirby, C. Brugman, CC Butler.  Family Practice, 2017, 1–8.  
M. K.D. Hawking, D. M. Lecky, P.Touboul, E.  Lundgren, E. Aldigs, E. Ioannidou ,D. Paraskeva-Hadjichambi, M. Gal, A. Ch. Hadjichambis, D. Mappouras, C.A.M. McNulty.

The Diagnosis of Urinary Tract infection in Young children (DUTY) Study Clinical Rule: Economic Evaluation. Hollingworth W, Busby J, Butler CC, O’Brien K, Sterne JA, Hood K, Little P, Lawton M, Birnie K, Thomas-Jones E, Harman K. Value in Health. 2017 Feb 22. In Press 

Comparison of microbiological diagnosis of urinary tract infection in young children by routine health service laboratories and a research laboratory: Diagnostic cohort study. Birnie K, Hay AD, Wootton M, Howe R, MacGowan A, Whiting P, Lawton M, Delaney B, Downing H, Dudley J, Hollingworth W, Lisles C, Little P, O’Brien K, Pickles T, Rumsby K, Thomas-Jones E, Van der Voort J, Waldron C, Harman K, Hood K, Butler CC, Sterne J. PloS one. 2017 Feb 15;12(2):e0171113. 

Nappy pad urine samples for investigation and treatment of UTI in young children: the ‘DUTY’ prospective diagnostic cohort study. British Journal of General Practice. Butler CC, Sterne JA, Lawton M, O’Brien K, Wootton M, Hood K, Hollingworth W, Little P, Delaney BC, van der Voort J, Dudley J, Birnie K, Pickles T, Waldron C, Downing H, Thomsas-Jones E, Lisles C, Rumsby K, Durbaba S, Whiting P, Harman K, Howe R, MacGowan A, Fletcher M, Hay A. British Journal of General Practice. 2016 Jul;66(648):e516-24.

Improving the Diagnosis and Treatment of Urinary Tract Infection in Young Children in Primary Care: Results from the DUTY Prospective Diagnostic Cohort Study. Hay AD, Sterne JA, Hood K, Little P, Delaney B, Hollingworth W, Wootton M, Howe R, MacGowan A, Lawton M, Busby J, Pickles T, Birnie K, O’Brien K, Waldron C, Dudley J, Van der Voort J, Downing H, Thomas-Jones E, Harman K, Lisles C, Rumsby K, Durbaba S, Whiting P, Butler CC. Annals of Family Medicine 2016;14:325-336. doi: 10.1370/afm.1954. 

Empiric antibiotic treatment for urinary tract infection in preschool children: susceptibilities of urine sample isolates. Butler CC, O’Brien K, Wootton M, Pickles T, Hood K, Howe R, Waldron CA, Thomas-Jones E, Dudley J, Van Der Voort J, Rumsby K, Little P, Downing H, Harman K, Hay A. Family Practice, 2016, Vol. 33, No. 2, 127–132 doi:10.1093/fampra/cmv104 

The Diagnosis of Urinary Tract Infections in Young Children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness. Hay A, Birnie K, Busby J, Delaney B, Downing H, Dudley J, Durbaba S, Fletcher M, Harman K, Hollingworth W, Hood K, Howe R, Lawton M, Lisles C, Little P, MacGowan A, O’Brien K, Pickles T, Rumsby K, Sterne J, Thomas-Jones E, Van Der Voort J, Waldron C, Whiting P, Wootton M, Butler CC, on behalf of the DUTY team. Health Technology Assessment 2016;20(51)