1. Presentation Title 36pt Arial Bold
Date
Antimicrobial Stewardship Essentials
Presentation Title 36pt Arial Bold
Sub heading 24pt Arial
Antimicrobials
Antibacterials (Antibiotics)
Antivirals
Antiparasitics
Antifungals

2. Date
Content
Statutory obligations for prudent use of antimicrobial prescribing
Prudent antibiotic prescribing: UK initiatives
Local antimicrobial guidelines & prescribing monitoring
National target: Commissioning for Quality and Innovation (CQUIN) – 2d Reduction in antibiotic consumption per 1,000 admissions and proportion of board spectrum antibiotic use

3. Date
National Framework for Infection Control: Code of Practice for Health & Social Care Act 2008 (the “Hygiene Code”) updated 2015
Code of Practice - statutory obligations Ensure appropriate antibiotic use to optimise patient outcomes and to reduce risk of adverse events and antimicrobial resistance

4. Prudent antibiotic prescribing: a UK initiatives

5. “ Antimicrobial Stewardship”
➤ is an inter-professional effort, across the continuum of care
➤ involves timely and optimal selection, dose and duration of an antimicrobial
➤ for the best clinical outcome for the treatment or prevention of infection
➤ with minimal toxicity to the patient
➤and minimal impact on resistance and other ecological adverse events such as C. difficile”
Nathwani et al, 2012

8. Prescribing tools Trust Prescribing policy & Treatment guidelines
Smartphone/i-phone: Microguide App by Horizon
“Surrey and Sussex NHS Adult Antimicrobial Guidelines/policies”
Version also available on Trust intranet
‘Start Smart then Focus’

10. Follow local antibiotic prescribing guidance

11. Workspaces

12. MICROGUIDE Web Browser

13. Antimicrobial prescribing do consider the following:
Evidence of infection? Do patients need antibiotics?
Shortest effective course, appropriate dose and route
Allergy status
Consider risk of Antimicrobial resistance and healthcare associated infections e.g. C difficile
Documentation of clinical diagnosis and decisions
Consider microbiological samples and review when available (the presence of bacteria does not necessarily mean there is an infection)

14. Broad spectrum / C.difficile risk antibiotics
The “5 Cs”
Cephalosporins
Ciprofloxacin (and other quinolones)
Co-amoxiclav (augmentin)
Clindamycin
Clarithromycin (& other macrolides)
“Should be avoided unless there are clear clinical indications for their use”

15. Duration of antibiotics - IV
“Treatment with IV antibiotics should not continue beyond hours unless recommended by local guideline or microbiologist”
“Rationale for continuing IV should be clearly documented with a new review date/duration”

16. Duration of antibiotics - total
“Treatment with antibiotics should not continue beyond 7 days (IV and oral) unless recommended by local guideline or microbiologist”
Department of Health ARHAI Guidance 2011

17. Penicillin allergy classification
Avoid ALL beta lactam antibiotics
- Penicillins
- Cephalosporins
- Carbapenems
Avoid use of penicillins
- Consider cephalosporins and carbapenems if no acceptable alternatives
Severe / Life-threatening
Anaphylaxis
Other type 1 hypersensitivity (e.g. angioedema)
Stevens Johnson Syndrome
Non - severe
Mild non type 1 reactions
Mild skin reaction

18. Antimicrobial Stewardship
Antimicrobial prescribing - monitoring
Good Antibiotic Prescribing (GAP) Audits – monthly audits carried out by ward pharmacists
National benchmarking for antimicrobial consumption
Reduction targets introduced 2016/17:
Total antibiotic consumption
AWaRe antibiotics & Carbapenems. For more information click on:

19. Good Antibiotic Prescribing (GAP): the care bundle “ all or nothing approach”
Compliance was measured using all 6 criteria as below: 1
Clinical indication for starting antibiotic therapy is recorded in the drug chart 2
A stop date or duration of antibiotic therapy is recorded on the drug chart 3
Evidence of antibiotic(s) reviewed within 72hrs of initiation and daily thereafter

20. All 6 care elements must be completed to achieve 100% compliance4
Choice of agent consistent with the trust antibiotic guideline.
If not included in the trust guideline, the antibiotic used is deemed clinically reasonable 5
Total duration of antibiotic ≤7 days (IV & PO) on audit day or according to guideline/consultant microbiology advice 6
IV duration currently ≤ 72 hrs (surgical prophylaxis ≤ 24hr) or according to guideline
All 6 care elements must be completed to achieve 100% compliance

21. References/CPD
PHE Antimicrobial Resistance- Resources Handbook, Mar 2017
WHO Antimicrobial Stewardship: competency-based approach (open learning)
UK Massive Open Online Course (MOOC) on Antimicrobial Stewardship