1. SEL Antimicrobial Awareness
Organisations in SEL can adapt this presentation (with local logos/background) for use as part of their antibiotic awareness campaign for 2018/19.
SEL Antimicrobial Awareness
[insert CCG/Trust] Medicines Optimisation Team/Pharmacy
Presented by: [insert name here]
[insert role here]
*Presentation slides are adapted from the
Target Antibiotics presentation, RCGP & PHE

2. Prof. Dame Sally Davies. CMO, 2013
“ There are few public health issues of potentially greater importance for society than antibiotic resistance”
Prof. Dame Sally Davies. CMO, 2013

3. Aims of the Workshop Brief background
Discuss some clinical cases where we could improve our antibiotic prescribing
Suggest strategies and share materials
Show evidence for using the material
Provide evidence showing the link between antibiotic prescribing and resistance in your patients
Show how reducing antibiotic prescribing can reduce antibiotic resistance, and also patient consultations

4. Context
If we don’t tackle drug resistant infections now, they could kill an across the world by 2050.
In the UK, 80% of antibiotic prescribing occurs in community.
extra 10 million people
each year

5. UK Prescribing: 80% of antibiotics are prescribed in general practice
DDD = Defined Daily Doses

6. Europe Prescribing: EU Community Antibiotic Consumption

7. South East London Primary Care Prescribing: Antibiotic Consumption
NHS Target: 1.161
England value: 1.028

8. South East London Primary Care Prescribing: Antibiotic Consumption
NHS Target: 10%
England value: 8.7%

9. South East London Primary Care Prescribing: Antibiotic Consumption

10. Antibiotic Prescribing in Primary Care vs. European Targets

11. Why do GP staff prescribe antibiotics?
Relief of symptoms
Worry about complications/more serious illness
Patient pressure

12. Symptom Benefit from Antibiotics
There is a need to convey this message to patients

13. Antibiotics and Complications
Serious complications are rare after URTI (Upper Respiratory Tract Infections)
Sore throat and otitis media NNT (Numbers Needed to Treat)* >4000
Pneumonia more common after LRTI (Lower Respiratory Tract Infection)
Age >65: NNT 39
Age<65: NNT >100
NNT = The average number of patients who need to be treated to prevent one additional bad outcome

14. Reducing Complication Risk
Empowering clinicians to give
Careful clinical assessment, including targeting treatment to those most at risk (clinical tools).
Back up/delayed antibiotics.
Safety netting including patient information leaflets.

15. The TARGET Antibiotic Toolkit

16. Clinical Scenario: Acute Cough

17. Clinical Scenario: Acute Cough
Please consider the following details:
45 year old smoker with cough for 1/52, green sputum
Temperature: 37.8 Degrees Celcius
Has had several previous episodes of bronchitis and insists antibiotics ‘always help’
PEFR (Peak Expiratory Flow Rate) normal
Scattered coarse creps (crackles, crepitation) and wheeze, vesicular breath sounds, no focal crepitations

18. Clinical Scenario Acute Cough: PHE Antibiotic Management Guidance

19. Clinical Scenario Acute Cough: Feedback
Antibiotic little benefit as no co-morbidity
Consider no, or 7 day back-up antibiotic with safety netting
Share a leaflet with the patient – e.g.. TARGET RTI leaflet
Advise the patient that symptom resolution can take 3 weeks

20. Prescribing: Consultations, and amoxicillin prescribing for acute cough & cold has increased
Consultation rates related to prescribing
In a longitudinal study, practices who reduced prescribing experienced a reduced consultation rate
Thus patients can be retrained not to expect antibiotics reducing the number of consultations

21. The Patient Perspective: What do patients do when they have an RTI?

22. The Patient Perspective: Why they visited GP with RTI (not cold/runny nose)

23. The Patient Perspective: A 2017 survey showed patients trust healthcare professionals advice

24. The Patient Perspective: Back-up/delayed Prescribing: What patients do

25. Evidence: Risk of resistance persists for at least 12 months after prescribing

26. TARGET: Patient Information Leaflets Treating Your Infection RTI Leaflet

27. TARGET: e-Bug & TARGET Pictorial TYI Leaflet

28. TARGET: Resources for clinical and waiting areas

29. Acute Cough: Reflect on actions your practice can take to improve prescribing

30. Clinical Scenario: Urinary Tract Infection (UTI)

31. Evidence: Antibiotic Resistance is Increasing

32. Clinical Scenario UTI: Elderly Patient
Please consider the following details:
80 year old resident in nursing home
Strong smelling urine, but clear looking
Increasing confusion over 2 days
Positive dipstick – nitrites and leucocytes
No history of fever, temp 37.4 degrees Celcius
Has had antibiotics in the past for suspected UTI

33. Clinical Scenario UTI: Elderly Patient
Ask about:
New or worsening urgency/incontinence, frequency
Suprapubic pain or flank or loin tenderness, or
Gross haematuria
Hydration, and fluid intake
Other symptoms suggesting another infection
Why was the patient given previous Abx, and were they and for how long?
Recent hospitalisation and operations
Also look for signs of sepsis or pyelonephritis

34. Clinical Scenario UTI: Elderly Patient
Criteria for initiating antibiotics include:
Acute dysuria alone OR dementia/delirium
Fever (>37.9 degrees C or 1.5 degrees C increase above baseline)
AND ≥ 1 new or worsening urgency/incontinence, frequency, signs of irritation of the urinary tract such as suprapubic pain or flank or loin tenderness, or gross haematuria
First line treatment in elderly now nitrofurantoin for 3 days
If eGFR <45 ml/min send urine and start pivmecillinam
Also look for signs of sepsis – if present then admit.

35. UTI PHE Guidance: Risk factors for resistance

36. TARGET: Patient Information Leaflets Treating Your Infection UTI Leaflet

37. Consider: Audits can help inform your prescribing behaviour

38. What can you do to learn more about UTI? Use TARGET Training Resources

39. How could your practice improve antibiotic prescriptions for UTI?

40. Possible Solution for You?

41. Action Planning: Developing priorities, for you now

42. Veterinary Antimicrobial Use
The UK Government’s Veterinary Medicines Directorate monitors and conducts surveillance on antimicrobial usage in animals.
Several important milestones have been achieved with regard to antimicrobial usage in animals:
Livestock and fish farmed for food antibiotic usage has reduced to an average of 50mg/kg in 2018 from 62mg/kg in 2014
Antibiotic usage in food producing animal species has decreased by 27% to 45mg/kg
The total usage of veterinary antibiotic sales of 337 tonnes is the lowest ever recorded since reporting began in 1993.
Highest priority critically important antibiotics (HP-CIAs) shown reductions in sales, including an 83% reduction in sales of colistin use for food producing animals.
Reductions in antibiotic use of 34% in pigs, 37% in chickens, 57% in turkeys and 60% in ducks in 2016
The pig and poultry industry has reduced HP-CIAs use of 73% and 78% respectively in 2016.
For more information on the Veterinary Usage of Antimicrobials please see: UK – Veterinary Antibiotic Resistance and Sales Surveillance Report 2016 (UK-VARSS 2016)

43. In [Insert CCG/Trust name]
[Add localised information on Antimicrobial projects and resources available in your borough]

44. Thank you.