Spotlight on managing common infections and antimicrobial prescribing Antimicrobial resistance is complex and increasing, with few new antimicrobial medicines coming to market. The appropriate use of all existing antimicrobials is therefore even more important than ever before. The Department of Health and Social Care UK 5-year antimicrobial resistance strategy 2013–18,1 outlines approaches to slowing the development and spread of antimicrobial resistance. The strategy states that antimicrobial resistance cannot be eradicated but, by using a multidisciplinary approach, the risk of antimicrobial resistance can be limited, and its impact on health now and in the future can be reduced. One of the main aims is to conserve and steward the effectiveness of existing antimicrobials. NICE has previously published guidelines and standards on antimicrobial stewardship, and these are all brought together in a NICE pathway.2 To further support the use of appropriate antimicrobials, NICE has a new programme of work for developing antimicrobial prescribing guidelines for managing specific common infections. These guidelines provide recommendations for all people (except those under 72 h of age) in all care settings. The guidelines focus on specific infections and give recommendations for when, or when not, to use an antimicrobial medicine. Where an antimicrobial is required, guidance is given on which specific antibiotic to use, at what dose and for how long. The guidelines also incorporate alternative options for treatment, such as back-up (delayed) prescribing, where evidence supports this. The guidelines are developed by a standing committee of topic experts who have an interest in antimicrobial resistance. Topics The first eight topics for antimicrobial prescribing guidelines include sinusitis (acute), sore throat (acute), otitis media (acute), urinary tract infections (lower, recurrent, pyelonephritis and catheter-associated) and prostatitis (acute). Future topics are being considered in conjunction with Public Health England. NICE has already published the guidelines on the self-limiting infections, sinusitis3 and sore throat.4 Antimicrobial resistance Public Health England publishes an annual report from the English surveillance programme for antimicrobial utilisation and resistance (ESPAUR).5 This report includes national data on antibiotic prescribing and resistance, and hospital antimicrobial stewardship implementation. Information on antimicrobial resistance, drawn from this report, is considered by the NICE committee when developing recommendations. This is in addition to reviewing research evidence identified from literature searches. This enables recommendations to be aligned with the strategy for reducing inappropriate antimicrobial use to minimize the risk of antimicrobial resistance. Guideline presentation Following stakeholder feedback on implementation of NICE guidance, an innovative approach has been used to present the guidelines. They adopt a layered approach, with a visual summary (a diagram of all the guideline recommendations), a short guideline and a longer evidence review. This approach allows users to access the information they need quickly and easily to support shared decision-making with patients. The visual summary provides an overview of the guideline recommendations and also antibiotic choice tables including antibiotic name, formulation, dose and duration of treatment (Fig. 1). Fig. 1 View largeDownload slide Visual summary for sore throat (acute). Source: https://www.nice.org.uk/guidance/ng84/resources/visual-summary-pdf-4723226606. Fig. 1 View largeDownload slide Visual summary for sore throat (acute). Source: https://www.nice.org.uk/guidance/ng84/resources/visual-summary-pdf-4723226606. Additionally, decision-making diagrams to help explain why antimicrobials may not be the best course of action for some self-limiting infections are given within the ‘information for the public’ sections of each guideline.3 The diagrams show how many people are likely to benefit from antibiotics and how many people are likely to experience side effects from antibiotics for that infection. The published NICE antimicrobial prescribing guidelines are co-branded with Public Health England. Other NICE assessments on antimicrobials In response to recommendations in the O’Neill report,6 the Department of Health and Social Care is working with industry, NICE and NHS England to develop options for new funding models for innovative antimicrobials supporting antimicrobial stewardship by delinking payments to companies from the volumes used. Recognizing that undertaking meaningful Technology Appraisals on antimicrobials could be technically challenging. The project (being undertaken by the DH Economic Evaluation Policy Research Unit [EEPRU]) is exploring the concept of undertaking Technology Appraisals on new antimicrobials offering high potential to address unmet need. In the short to medium term NICE is producing antimicrobial prescribing evidence summaries to support appropriate use and stewardship of new antimicrobials. A new format has been developed for the summaries. The first is on ceftazidime-avibactam.7 References 1 Department of Health and Social Care. The UK Five Year Antimicrobial Resistance Strategy 2013 to 2018. London: Department of Health and Social Care. (https://www.gov.uk/government/publications/uk-5-year-antimicrobial-resistance-strategy-2013-to-2018) (8 March 2018, date last accessed). 2 National Institute for Health and Care Excellence. Antimicrobial Stewardship. London: National Institute for Health and Care Excellence, 2015. (https://pathways.nice.org.uk/pathways/antimicrobial-stewardship) (14 March 2018, date last accessed). 3 National Institute for Health and Care Excellence. Sinusitis (Acute). London: National Institute for Health and Care Excellence, 2017. (https://www.nice.org.uk/guidance/ng79) (14 March 2018, date last accessed). 4 National Institute for Health and Care Excellence. Sore Throat (Acute). London: National Institute for Health and Care Excellence, 2017. (https://www.nice.org.uk/guidance/NG84) (14 March 2018, date last accessed). 5 Public Health England. English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report. London: Public Health England, 2017. (https://www.gov.uk/government/publications/english-surveillance-programme-antimicrobial-utilisation-and-resistance-espaur-report) (14 March 2018, date last accessed). 6 HM Government. Review on antimicrobial resistance. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. London: HM Government, 2016. (https://amr-review.org/) (14 March 2018, date last accessed). 7 National Institute for Health and Care Excellence. Antimicrobial Prescribing: Ceftazidime/Avibactam. London: National Institute for Health and Care Excellence, 2017. (https://www.nice.org.uk/advice/es16) (14 March 2018, date last accessed). © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. 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Journal of Public Health – Oxford University Press
Published: Apr 10, 2018
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