About ARK

Antibiotics are essential to treat serious infections caused by bacteria. Unfortunately, the more bacteria are exposed to antibiotics, the more likely they are to become resistant. This means that antibiotics stop working. So it is important that antibiotics are only used when they are needed.

Whilst antibiotics kill bacteria, they don’t cure viral infections. When sick patients arrive at hospital, doctors have to try to work out whether they have a bacterial infection, viral infection, or another illness altogether. This is difficult, because initially the symptoms can be very similar (e.g. cough, temperature).

Finding out exactly why a patient is sick takes a while, so it makes sense to give antibiotics initially. However, Department of Health guidance recommends stopping antibiotics when it becomes clear that they aren’t needed anymore. This could be because doctors work out that the patient never had a bacterial infection, or because they have got better. Stopping antibiotics when they aren’t needed reduces the chances of disease-causing and other gut bacteria becoming resistant to antibiotics. It is also important because antibiotics kill ‘friendly’ gut bacteria.

However, stopping antibiotics when they are no longer needed often doesn’t happen. Sometimes this is ‘just in case’ or thinking ‘better safe than sorry’, or because of the myth that antibiotic courses must be completed to avoid resistance. But, because gut bacteria, rather than those causing disease, become antibiotic-resistant during treatment, taking more antibiotics than really needed is not a safe strategy for the future.

There is no good evidence on how best to encourage doctors to stop giving unnecessary antibiotics in hospitals and changing behaviour is hard. The ARK-Hospital Programme is seeking to address this by developing a package of measures – the ‘Antibiotic Review Kit’ – to help healthcare staff stop antibiotics when they are no longer needed, and by testing this package to see if it reduces overall antibiotic use.

Read a recent BBC News article on antibiotic resistance here, or listen to Prof Laura Piddock discussing the issue on BBC Radio 4 Today Programme here.

ARK is developing and testing a bundle of strategies – the ‘Antibiotic Review Kit’ – to help doctors, nurses, pharmacists and patients stop antibiotics in hospital when they are no longer needed.

The programme has six elements (work packages).

  1. Summary of the published evidence for the effectiveness and safety of shorter antibiotic courses in hospitalised patients.
  2. Analysis of existing electronic hospital data on antibiotic prescribing and on patients’ outcomes, to check that there is no other evidence that stopping antibiotics could harm patients.
  3. Interviews with healthcare professionals and patients/carers to understand better their perceptions and experiences of antibiotic prescribing, and to identify potential barriers to changing current practice.
  4. Development of the ‘Antibiotic Review Kit’. The package includes an internet-based education tool, a new way of categorising antibiotic prescriptions to help doctors and other healthcare professionals review patients and materials for patients themselves.
  5. Clinical trial to test the Antibiotic Review Kit in up to 36 hospitals, comparing what happens before and after its introduction.
  6. Study of how healthcare professionals weigh up the costs and benefits of reducing antibiotic use, and the cost-effectiveness of the Antibiotic Review Kit.

The first four work packages are completed, including a feasibility study testing the impact of the Antibiotic Review Kit on antibiotic use at Brighton, a pilot study in three sites, and the main trial has finished recruitment.

The Antibiotic Review Kit was first introduced at Royal Sussex County Hospital, Brighton in April 2017, where we conducted a feasibility study to understand how it is used in practice and what effect it has. We aim to reduce overall exposure to antibiotics by more than 15%. We will also assess if patients’ health is affected at all, to make sure this can be done safely.

We rolled out ARK across several more pilot sites over September-November 2017 and then in a total of up to 36 hospitals across England during 2018-19.

ARK trial privacy notice 2019 ARK-trial privacy note 2019-08-23

Here is a list of the trial sites by randomisation:

  • Brighton and Sussex University Hospital NHS Trust
  • Wexham Park Hospital
  • South Tees Hospitals NHS Foundation Trust
  • Oxford University Hospitals NHS Trust
  • Buckinghamshire Healthcare NHS Trust
  • Royal Berkshire NHS Foundation Trust
  • Southport & Ormskirk Hospitals NHS Trust
  • South Eastern Health and Social Care Trust (NI)
  • Royal Free London NHS Foundation Trust
  • Plymouth Hospitals NHS Trust
  • York Teaching Hospital NHS Foundation Trust
  • Nottingham University Hospitals NHS Trust
  • Royal Cornwall Hospitals NHS Trust
  • Royal Devon and Exeter NHS Foundation Trust
  • Surrey and Sussex Healthcare NHS Trust
  • North Cumbria University Hospitals NHS Trust
  • Countess of Chester Hospital NHS Foundation Trust
  • London North West Healthcare NHS Trust (Northwick Park)
  • Wye Valley NHS Trust
  • Western Health and Social Care Trust, Altnagelvin Area Hospital (NI)
  • Northern Health and Social Care Trust (NI)
  • Mid Yorkshire Hospitals NHS Trust
  • Western General Hospital, Edinburgh, NHS Lothian
  • Northern Devon Healthcare NHS Trust
  • The Royal United Hospitals Bath NHS Foundation Trust
  • North Tees and Hartlepool NHS Foundation Trust
  • Southern Health and Social Care Trust
  • East Suffolk and North Essex NHS Foundation Trust
  • Poole Hospital NHS Foundation Trust
  • Great Western Hospitals NHS Foundation Trust
  • Betsi Cadwaladr University Health Board  – Bangor
  • Newcastle upon Tyne NHS Foundation Trust
  • North Middlesex University Hospital NHS Trust
  • Wirral University Teaching Hospital
  • Airedale NHS Foundation Trust
  • East Kent Hospital NHS Foundation Trust
  • Swansea Bay University Health Board (previously Abertawe Bro Morgannwg University Health Board)
  • Chesterfield Royal Hospital NHS Foundation Trust
  • The Royal Wolverhampton NHS Trust
  • Milton Keynes University Hospital NHS FT Trust