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