Antibiotic Review Kit for Hospitals (ARK-Hospital)
Tools to support NHS Hospital Trusts successfully implement ARK and protect patients from antibiotic over use
Welcome to the ARK-Hospital Resources website
This website has been created as a permanent home for the diverse resources developed to support implementation of the Antibiotic Review Kit
Watch the short video explaining the importance of ARK
At each hospital trust introducing ARK, its implementation is led by an ARK Champion and Core Team, involving the trust’s Antimicrobial Stewardship Team and clinical staff considered essential to establish and sustain ARK. On the pages of the site you can find information about the different components of ARK.
The ARK-hospital intervention has four components
These can be viewed below.
A brief (7-10 min) online tool that promotes motivation and confidence to implement ‘review and revise’, by discussing the risks and benefits associated with antibiotic treatment duration decisions and introducing the Decision Aid.
Allows prescriber to acknowledge and record the degree of certainty around starting antibiotics and link this to the prescription review decision. Antibiotics can be prescribed as either:
- Pending diagnostic review. This was termed the “initial” prescription in the original research and equates to “Start smart”. Whatever terminology is used, it recognises that diagnostic uncertainty almost always exists when antibiotics are first started. Antibiotics started pending diagnostic review are categorised as prescribed for either:
- ‘possible’ infection (infection less likely but antibiotics are being prescribed until serious infection can be excluded) or
- ‘probable’ infection (infection is likely but more information is required before finalising the diagnosis/treatment).
- Reviewed. At review, many prescriptions can be stopped because there isn’t a clear indication for antibiotics to be continued beyond 28-72 hours. Where there is a clear indication for antibiotics, a reviewed prescription can be written where a senior/specialist decides on agent, route, and duration.
Establishing and sustaining good antibiotic prescribing with ARK depends on regular, low-burden audit and feedback to prescribers.
This should use point-prevalence data and inform brief, frequent and supportive discussions with clinical teams about Decision Aid use and rates of stopping antibiotics, reinforcing learning about antibiotic prescribing decisions.
Explains the ‘review and revise’ process, why antibiotics may be stopped, then potentially restarted, and gives safety-netting advice. Ensures patients and their families are involved in decisions about antibiotic treatment.
A brief (7-10 min) online tool that promotes motivation and confidence to implement ‘review and revise’, by discussing the risks and benefits associated with antibiotic treatment duration decisions and introducing the Decision Aid.
Allows prescriber to acknowledge and record the degree of certainty around starting antibiotics and link this to the prescription review decision. Antibiotics can be prescribed as either:
- Pending diagnostic review. This was termed the “initial” prescription in the original research and equates to “Start smart”. Whatever terminology is used, it recognises that diagnostic uncertainty almost always exists when antibiotics are first started. Antibiotics started pending diagnostic review are categorised as prescribed for either:
- ‘possible’ infection (infection less likely but antibiotics are being prescribed until serious infection can be excluded) or
- ‘probable’ infection (infection is likely but more information is required before finalising the diagnosis/treatment).
- Reviewed. At review, many prescriptions can be stopped because there isn’t a clear indication for antibiotics to be continued beyond 28-72 hours. Where there is a clear indication for antibiotics, a reviewed prescription can be written where a senior/specialist decides on agent, route, and duration.
Establishing and sustaining good antibiotic prescribing with ARK depends on regular, low-burden audit and feedback to prescribers.
This should use point-prevalence data and inform brief, frequent and supportive discussions with clinical teams about Decision Aid use and rates of stopping antibiotics, reinforcing learning about antibiotic prescribing decisions.
Explains the ‘review and revise’ process, why antibiotics may be stopped, then potentially restarted, and gives safety-netting advice. Ensures patients and their families are involved in decisions about antibiotic treatment.
Why ARK was developed
Antibiotics are vital for treating serious bacterial infections. Unfortunately, the more antibiotics are used the more bacteria can become resistant to them. This means that antibiotics will stop working. So, it is important that antibiotics are only used when necessary.
When patients are ill enough to need hospital treatment, doctors have to try to work out if they have a bacterial infection, viral infection, or another illness altogether. This is difficult, because different things can cause similar symptoms (e.g. cough, headache, temperature).
It takes time to find out exactly why a patient is sick, so doctors often start antibiotics straightaway. In this situation, good practice is to stop antibiotics when it becomes clear that they’re no longer needed. This could be because tests show the patient didn’t have a bacterial infection, or because the patient is better. Stopping antibiotics when they aren’t needed reduces the chances of resistance developing. It also reduces the impact on ‘friendly’ gut bacteria which help keep us healthy and protect us from other ‘bad’ bacteria.
In real life, stopping antibiotics as recommended often doesn’t happen. Sometimes this is ‘just in case’ or thinking ‘better safe than sorry’.
How ARK was developed
In the original Antibiotic Review Kit (ARK) research we worked with NHS staff, researchers and patients to develop tools to help doctors stop unnecessary antibiotics promptly.
A study across 39 NHS hospitals showed that implementing the ARK tools reduced antibiotic use, safely. You can read a summary of the research here.
In 2022 UK guidance for hospital antibiotic prescribing “start smart then focus” was updated to recommend trusts embed ARK in their stewardship programmes.
In the original research, ARK was implemented predominantly in paper-based prescriptions which have now been replaced with electronic prescribing systems across NHS hospitals.
From 2024-2026 the Speed-up ARK project updated the ARK tools to account for updates in evidence, lessons from the original research and to develop support for implementing the decision aid in electronic prescribing systems.
As with the original research, Speed-up ARK was primarily the work of NHS staff stakeholders working at hospitals across the UK supported by a team of patient representatives.
The resources developed through Speed-up ARK are now all freely available through this website to support hospitals implement ARK and protect patients from the harms of antibiotic over use.
Funding and support for ARK
Both the original ARK research and Speed-UP ARK were funded by the National Institute for Health and Care Research (NIHR) via its Programme Grants for Applied Research.
Additional funding from NHS England supported development of the online learning module
Throughout the work the British Society for Antimicrobial Chemotherapy have provided expertise and resources to support the online learning, communications and development of this website.
Most importantly ARK would not exist without the work and support of hundreds of NHS staff and the patient and public advisors, some of whom have worked on ARK for almost 10 years.