Reducing antibiotic prescribing for children presenting to primary care with acute respiratory tract infection

Blair, P.S. et al. (2017) BMJ Open. 7:e014506

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Objective: To investigate recruitment and retention, data collection methods and the acceptability of a ‘within-consultation’ complex intervention designed to reduce antibiotic prescribing.

Conclusion: Differential recruitment may explain the paradoxical antibiotic prescribing rates. Future cluster level studies should consider designs which remove the need for individual consent postrandomisation and embed the intervention within electronic primary care records.

Read the full article here

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Reducing the impact of serious infections CQUIN

Resources to support delivery of the ‘Reducing the impact of serious infections (antimicrobial resistance and sepsis)’ CQUIN, parts 2c and 2d | NHS Improvement

  • Reducing the impact of serious infections CQUIN, parts 2c and 2d – questions and answersPDF, 185.4 KB – Questions and answers relating to parts 2c and 2d of the ‘Reducing the impact of serious infections’ CQUIN.
  • Part 2c data collection and submissionXLSX, 236.1 KB – PHE has developed this submission tool (and sample data collection form) to facilitate the submission of part 2c (antibiotic review). All data submitted will be available on AMR Fingertips.
  • Part 2d antibiotic consumption submission toolXLSM, 91.4 KB – The data submitted as part of this year’s antimicrobial resistance (AMR) CQUIN has been used to develop this baseline data. Providers that did not take part in the 2016/17 AMR CQUIN or submitted previous annual data should submit quarterly data from January to December 2016, using the antibiotic consumption spreadsheets available on the NHS England AMR CQUIN webpage. Without this data a baseline cannot be calculated for your provider.
  • Part 2d baseline dataXLS, 259.5 KB – Use this to submit quarterly antibiotic consumption data to PHE. All data once submitted will be available via AMR Fingertips after an eight week data cleaning period.

Progress report on the UK 5 year antimicrobial resistance (AMR) strategy

Department of Health | Published online: 16 September 2016

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Image source: gov.uk

Lord O’Neill’s review, ‘Tackling drug-resistant infections globally’ made 10 recommendations on how to best prevent the challenge of antimicrobial resistance (AMR). The recommendations include raising awareness of AMR globally, reducing the use of antibiotics in animals and improving hygiene to help stop the spread of infection.

 

The UK government response accepts these recommendations as part of its ongoing AMR strategy. The government also published its second annual progress report on the UK’s 5 year AMR strategy.

Lord O’Neil’s report also highlights the consequences if we do not act to prevent the growing crisis – predicting 10 million deaths a year by 2050, an effect on the world economy of $100 trillion, and the potential end of modern medicine as we know it.

The UK is already leading on a range of measures aimed at preventing AMR across the globe. These include:

  • investing £265 million to strengthen the surveillance of antimicrobial use and resistance, which is already helping 11 countries worldwide and will be expanding in 2017
  • using a £50 million investment to start a global AMR innovation fund to develop new antimicrobials along with diagnostic tools and vaccines
  • investing in the development of quick diagnosis tests, making sure people are given the right drugs for the right infection at the right time, the new tests, once proven to be effective, will available in both the UK and internationally
  • almost halving the British meat poultry industry’s use of antibiotics between 2012 and 2015 through improvements in training, stewardship, and disease control

Read the full report here

A Comprehensive Review of Common Respiratory Infections Encountered in Urgent and Primary Care

Beam, C. et al. Journal of Emergency Nursing. Published online: 21 July 2016

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Concern about antibiotic overuse has become heightened as bacterial resistance to antibiotics continues to increase. Patients experiencing respiratory symptoms frequently present to urgent/emergent care settings such as fast-track emergency care departments and primary care retail settings with the expectation that they will be prescribed antibiotics.
The Centers for Disease Control and Prevention (CDC) reports that approximately 2 million people will become ill with bacteria that are resistant to at least one antibiotic, approximately 23,000 people die as a direct result of these infections, and many others die as a result of complications related to antibiotic-resistant infections.
Read the abstract here

NHS Behind the Headlines – Reduced antibiotic prescribing did not raise serious infection rates

NHS Choices. Published online: July 7 2016

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“Surgeries that handed out the fewest pills do not have higher rates of serious illnesses,” the Daily Mail reports.

A new study looked at the impact of prescribing patterns of antibiotics by GPs. The researchers were particularly interested in seeing what happened in practices where GP’s did not usually prescribe antibiotics for what are known as self-limiting respiratory tract infections (RTIs).

This cohort study aimed to determine whether the incidence of some diseases was higher in general practices that prescribe fewer antibiotics for self-limiting respiratory tract infections (RTIs).

It found that alongside reductions in the rate of antibiotics prescribed, rates of incidence for peritonsillar abscesses, mastoiditis and meningitis declined. Pneumonia showed a slight increase and no clear change was observed for empyema and intracranial abscesses.

The study had a good sample size, and represented the UK population well in terms of age and sex. However, there are a few points to note:

  • As the researchers acknowledged, the study observed outcomes from a population perspective and therefore was unable to deal with variations in prescription at the individual doctor or patient level.
  • This study only looked at data collected from GP surgeries, and prescription and infection incidence rates may be higher in emergency departments or out-of-hours practices which this study was not able to capture.
  • Finally, due to its study design, these findings can’t confirm cause and effect. It is possible that unmeasured confounders influenced the reported associations.

The researchers hope these findings will potentially be used in the context of wider communication strategies to promote and support the appropriate use of antibiotics by GPs.

Patients can also help by not pressuring GPs for antibiotics “just in case” they may need them.

Read the full analysis here

Read the original research article here

ANTIMICROBIAL RESISTANCE: A Patients Association report to assess whether Clinical Commissioning Groups are fulfilling their stewardship responsibilities in the battle against antibiotic resistance

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Image source: Patients Association

The threat of antimicrobial resistance (AMR) represents arguably the greatest patient safety challenge of our time. It has been widely reported that the world is on the cusp of a ‘post-antibiotic era’, with the growth in treatment-resistant bacteria raising the prospect that modern medicine will be increasingly unable to treat what are currently considered to be routine infections. Without effective antibiotics, cancer treatments, childbirth and many other operations would also be far riskier. If we are unable to reverse this trend, it has been estimated that AMR could kill up to 10 million people a year by 2050, with a cumulative cost to the global economy of £70 trillion.

Evidence suggests that we may also be nearing this cusp sooner than originally thought. In December 2015, a report in the Lancet Journal of Infectious Diseases demonstrated that certain strains of bacteria found in patients and livestock across China had started to become resistant to the ‘last resort’ antibiotic colistin.8 This development effectively means that bacteria causing a number of gut, urinary and blood infections in humans are at risk of developing pan-resistance, and could become untreatable by all currently-available antibiotics.

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Image source: Patients Association

In recognition, this report explores the extent to which Clinical Commissioning Groups (CCGs), key organisations in terms of delivering local antimicrobial stewardship (AMS) programmes, are taking the challenge on-board and enacting key recommendations helping to manage the threat of AMR.

Read the full report here

NHS England launches national programme to combat antibiotic overusage

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Image source: Global Panorama

NHS England has today launched the world’s largest healthcare incentive scheme for hospitals, family doctors and other health service providers to prevent the growing problem of antibiotic resistance.

Launched against the backdrop of the International Patient Safety Conference taking place at Lancaster House in London today, funding will be made available to hospitals and other providers that reduce the inappropriate use of antibiotics.

Antibiotic resistance is one of the most significant threats to patients’ safety worldwide and is driven by overusing antibiotics and prescribing them inappropriately. Infections with antibiotic-resistant bacteria increase levels of disease and death, as well as the length of time people stay in hospitals. As resistance in bacteria grows, it will become more difficult to treat infection, and this affects patient care.

The NHS’ new programme, which goes live in April 2016, will offer hospitals incentive funding worth up to £150 million to support expert pharmacists and clinicians review and reduce inappropriate prescribing. In addition, a typical local Clinical Commissioning Group with a population of 300,000 people could receive up to £150,000 a year to support GP practices improve their antimicrobial prescribing.

Read the full news story here