Looking back to move forwards: investigating the use of antibiotics for COVID-19

Using antibiotics when they aren’t needed can promote antimicrobial resistance. This is when bacteria change over time and no longer respond to medicines. It makes infections harder to treat and increases the risk of disease spread, severe illness and death.

During the pandemic, antibiotics were used to treat patients with more severe COVID-19. This is despite the fact that a virus causes COVID-19, and antibiotics don’t work against viruses. Usually antibiotics are given because doctors are concerned that there might be a bacterial infection on top of the COVID-19 infection making matters worse.

The NIHR-funded PEACH study is investigating whether a blood test helped doctors to make better decisions about whether to give antibiotics to patients with COVID. The test can detect a ‘marker’ called procalcitonin (PCT). This marker shows whether or not the patient has an active bacterial infection. However, there is a lack of clear evidence to support using the test in lung infections. This means that in some hospitals, clinicians have used the PCT test to make decisions on whether to give antibiotics in COVID-19, whilst in other hospitals, they have not.

The PEACH study involves many different hospital trusts and healthboards across England and Wales. As antibiotics were used differently in different hospitals, the study will look back and compare what was done at the time with what actually happened because of that action. The research team is gathering the data from different hospitals into a single place. They hope to learn as much as possible from what has been done to inform and guide the best approach for the future.

“The relevance and potential of authentic patient and public involvement to influence health and wellbeing in health and care research and policy were brought into sharp focus a few days ago. I heard BBC ‘Inside Science’ talking about the global health burden of resistance to antibiotics on the same day that I had participated as a public member of a research group investigating the use of antibiotics in the first wave of the coronavirus.” – Graham Prestwich, public contributor

Involving members of the public in designing research can improve its quality and relevance. In addition, people who are affected by research have a right to have a say in it.

Several patients and members of the public are on the study management group for the PEACH study. They attend the formal research team meetings and participate in the research updates and discussions. Importantly, the public members have an equal opportunity to contribute and ask about any aspects of the study. The research team also holds separate discussion forums for the public members of the management group to discuss various related topics. Some members of the group had personal knowledge and experience relevant to the COVID, bringing a different perspective to the research.

“It came as a great surprise when I was invited to participate in the process of this study.
The connection was that I had lived experience of being admitted to ICU for Covid-19 during the first wave in the March/April 2020 period. Spending 2 weeks in ICU was a life-changing experience. I certainly felt I had a voice and in the early days of getting used to Long Covid, being involved helped my mental health a lot. I did not feel invisible anymore!” – Chikezie Knox-Macaulay, patient representative

Public contributors were involved in the PEACH study from the start, with a member of the public being a co-applicant on the funding submission. In the study management group, the public contributors have also been able to flag potential challenges with the study. For example, the group discussed the nuances around antimicrobial resistance, which means the research will need to be carefully communicated to the public.

“I joined PEACH as a co-applicant pre-submission for funding. It was admirable that the team were committed to such early involvement. From knowledge sharing, I quickly realised that it isn’t about the response of the patient’s immune system but it’s about the bacteria changing over time and no longer responding to medication. This was a major learning curve for me personally. But it may be a huge challenge getting messages over to the wider public. When we are ill, it is all too easy to make that psychological leap to think ‘’I need antibiotics’’, so we must take care in communicating the findings of PEACH to the general public.” – Margaret Ogden, public contributor and co-investigator.

“I have gained so much and what was particularly striking was the fact that all these professionals were being so inclusive and open to the daftest of questions and comments. But actually, the important role lies beyond the process and the actual relevance to facts that challenge the anti-vaccine messages out in society. To participate was a great honour and the public participants have been able to contribute and help clarify the way forward, especially in the publication that allows the information and results to be user-friendly alongside the science.” – Chikezie Knox-Macaulay, patient representative

Looking back to improve the future

It is important for researchers to look back at what has been done, to make sure we learn from these experiences for the future. The PEACH study is making the best use of what is already known. But it is only when all the data are brought into a single place and scrutinised as a whole can we learn most about how to make better informed clinical decisions in the future. Patients and members of the public have been important in shaping this process, making this research more relevant and useful to patients and the public.

“The patient and public input to the PEACH project has been invaluable and we are lucky to have had such an engaged patient and public involvement (PPI) team. Our PPI representatives have a range of experience of input into research, resulting in a helpful mix of views and perspectives. PEACH includes some complicated statistics and a wide variety of research methods, challenging the rest of the research team to ensure the research is clearly explained and ensuring we give plenty of opportunity for questions. I think the process has been beneficial for all the team.” - Jonathan Sandoe, Associate Professor, University of Leeds

“As we grapple with the challenge of reducing the intolerable variation in the outcomes of care between our communities that has become even more apparent at least in part because of the system disruption that has taken place over the last two years, we must all think and act more deliberately and discover what to do differently to do better.” – Graham Prestwich, public contributor

More information

The PEACH study is funded by the NIHR (ref XP NIHR132254), and is led by Dr Jonathan Sandoe from the University of Leeds and Professor Enitan Carrol from the University of Liverpool. It is sponsored by the University of Leeds and coordinated by the Centre for Trials Research (CTR) at Cardiff University.

Useful links

• If you are interested in involving patients and the public in research you can start with our Briefing notes for researchers
• If you’re interested in getting involved as a member of the public, get started with our Starting Out Guide
• The study was funded by NIHR’s COVID Learning & recovery call, part of the Health Technology Assessment (HTA) Programme
• More information about the study is available on the NIHR’s Funding & Awards website or on the University of Cardiff website