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Prof Paul Little


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Paul Little has been a GP for 20 years, and is Professor of Primary Care Research at the University of Southampton. 

He is a Fellow of the Academy of Medial Sciences, a National Institute of Health Research (NIHR) Senior Investigator (emeritus), and winner of the Maurice Wood award (for Lifetime contribution to primary care research).  He has led a wide range of studies in acute infections – diagnostic studies, prospective cohorts, placebo controlled trials, pragmatic trials of antibiotic prescribing strategies, and complex interventions to address antimicrobial stewardship and reduce the threat to public health of antibiotic resistance.

Landmark publications: 

Following landmark trials developing open pragmatic trial methodology for antibiotic prescribing strategies (sore throat(1);otitis media(2);cough(3)), we developed and trialled a Sore throat score (FeverPAIN(4)) which improves symptom control and reduces antibiotic use, the 'Germ Defence' website which reduces GI and respiratory infections (MRC PRIMIT trial n=20,000)(5). I led the largest placebo controlled trial to date in acute chest infections in adults (n=2061)(6) which demonstrated very limited benefit of antibiotics, leading to the most recent trial in children(7).

1. Little PS, Williamson I, Warner G, et al. An open randomised trial of prescribing strategies for sore throat. B M J 1997;314:722-27.

2. Little P, Gould C, Williamson I, et al. A pragmatic randomised controlled trial of two prescribing strategies for acute otitis media. BMJ2001;322:336-42.

3. Little P, Rumsby K, Kelly J, et al. Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomised controlled trial. JAMA2005;293:3029-35.

4. Little P, Hobbs FD, Moore M, et al. Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management). Bmj 2013;347:f5806. doi: 10.1136/bmj.f5806 [published Online First: 2013/10/12]

5. Little P, Stuart B, Hobbs FDRea. An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial. Lancet 2015;DOI:

6. Little P, Stuart B, Moore M, et al. Amoxicillin for acute lower respiratory tract infection where pneumonia is not suspected clinically : a 12 country randomised placebo controlled trial in primary care. Lancet Infectious Disease 2013;Feb;13(2):123-9. doi: 10.1016/S1473-3099(12)70300-6.

7. Little P, Read RC, Becque T, et al. Antibiotics for lower respiratory tract infection in children presenting in primary care (ARTIC-PC): the predictive value of molecular testing. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2022 doi: 10.1016/j.cmi.2022.02.033 [published Online First: 2022/03/16]

Major grants: 

2021-2023 Platform Adaptive trial of NOvel antiviRals for eArly treatment of COVID-19 In the Community (PANORAMIC) £18,270,128 (NB 132k is the Southampton resource - for my salary and Dr Lown)

2019-2024 REducing Common infections in Usual practice for Recurrent Respiratory tract infections (the RECUR Programme; NIHR PGfAR  £2,462,362

2017-202 REducing and preventing COgnitive      impairment iN older age groups      (RECON) (NIHR PGfAR: £2,803,331).

2016-2022 Screen and TREAt for Malnutrition      (STREAM) Programme (NIHR      PGfAR:£2,728,152).

2016-2022 Cancer: Life Affirming Survivorship      support in Primary care (CLASP) Programme (NIHR PGfAR: £2,499,011).

2016-2022 ARTIC-PC Antibiotics for lower      Respiratory Tract Infection in      Children presenting in Primary Care (ARTIC PC) (NIHR HTA: £1,564,707).

2012-2020 CANDID development of prediction      rules for cancer (NIHR SPCR:      £2,085,433).

2012-2016 POWeR trial of obesity management      website (NIHR HTA: £1,090,461).

Impact example: 

The Chief Medical Officer (2011) and O’Neill (2016) reports on antimicrobial resistance (AMR) emphasise the urgency of curbing antibiotic use for acute respiratory tract infections (RTIs), the source of 60% of all antibiotic   prescriptions, to reduce the global threat of AMR. 

Major contributions by   Prof Little in trials and cohorts have demonstrated reductions in antibiotic use in RTIs using: delayed antibiotic prescriptions; a clinical score for pharyngitis (FeverPAIN); communication skills training; C-reactive protein (CRP) point-of-care tests; and a digital intervention to support handwashing. 

The research has formed a key part of 9 national and 4 international guidelines, two UK 5-year AMR strategies and a successful intervention by the CMO for overprescribing GPs. FeverPAIN has been used 100,000 times, the communication skills modules are used internationally, and delayed prescription is proven to be used in everyday practice internationally.

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