2. Overview Antibiotics – miracle medicines
Antibiotic resistance – a critical global problem
The link between antibiotic use and resistance
Addressing antibiotic resistance
The role of antimicrobial stewardship
Prescribing and using antibiotics with care
Whenever they are used, antibiotics must be used with care.
This presentation will cover:
The problem of antibiotic resistance today
Antibiotic resistance is recognised globally as a critical patient safety and public health issue
The link between antibiotic use and the development of resistance
The importance of responsible antibiotic use as one strategy to address antibiotic resistance
The role of antimicrobial stewardship in supporting the appropriate use of antibiotics
Information on Antibiotic Awareness Week.
The key message is that wherever antibiotics are used, they must be used with care, if we are to preserve the miracle of these life-saving medications. 2

3. The “miracle” of antibiotics
Discovery of penicillin revolutionised treatment of infectious disease
Increased life expectancy due to ability to prevent and treat infection
Crude mortality rates for all causes, non infectious causes and infectious diseases over the period
The most significant impact on increasing life expectancy in the last 100 years has been the ability to prevent and control infection through improvements in public health, such as sanitation, and vaccinations; and the ability to treat infection with antibiotics.
During the last century mortality rates from non infectious diseases has remained fairly constant, whilst deaths from infectious diseases has decreased markedly.
The red line depicts falling mortality rates due to infection.
Note to presenters: The spike at around 1920 occurs at the time of the Spanish flu pandemic. More information about the history of flu pandemics is available from the “Pandemic Influenza” page of the Department of Health web site.
1. Armstrong GL et al, JAMA 1999;281(1):61-66 3

4. Antibiotics continue to save lives, every day…
Ability to control infection is critical to other advances in medicine
Neonatal care
Transplantation
Chemotherapy
Immunosuppression
Complex and routine surgery
Obstetric care
Intensive care interventions
Advances in modern medicine such as those listed on this slide, undertaken routinely in many health care settings – have been possible largely due to the availability of effective antibiotics to prevent and manage infection. 4

5. But…antibiotics are a limited resource
Increasing antibiotic resistance
Increased use of antibiotics
Decreasing pipeline of new antibiotics
Urgent call to action
Antibiotic resistance (ABR) has been identified as a threat to patient safety.
There are growing rates of resistance to antibiotics in our hospitals and the community
The antibiotics we do have, we are not using appropriately
There are few new antibiotics being developed.
ABR threatens the capacity to prevent and treat infection - without antibiotics routine treatments such as those listed on the previous slide (that are often taken for granted) may not be possible.
Spellberg and colleagues from the Infectious Diseases Society in America, describes this situation as “The Perfect Storm”. The paper provides background to the scope of the problem.
In Australia, in 2011, in response to the looming crisis in antimicrobial resistance, the Australasian Society for Infectious Diseases and the Australian Society for Antimicrobials convened an Antimicrobial Resistance Summit, bringing together experts from the medical, veterinary, agricultural, infection control and public health sectors to establish priorities and a joint plan for action. The paper by Gottlieb and Nimmo, published in the MJA following the summit, highlights the key factors contributing to resistance and recommends priorities for action in Australia.
References for both papers are provided in the reference list for this presentation, available on the Antibiotic Awareness Week page of the Australian Commission on Safety and Quality in Health Care.
Hint – Presenters can print the reference list as a handout for participants.
2. Spellberg, B. et al. Clinical Infectious Diseases 2008; 46 (2):155-64
3. Gottlieb, T and Nimmo, G. Medical Journal of Australia 2011; 194 (6): 281-3 5

6. Emergence of antibiotic resistance
“It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body.”
Sir Alexander Fleming, 1945
The issue of antibiotic resistance was recognised early in the ‘antibiotic era’. It threatens our ability to control infection.
In accepting the Nobel Prize for his role in the discovery of penicillin, Alexander Fleming warned of the potential for resistance to penicillin to develop.
4. Sir Alexander Fleming, Nobel Lecture, December 1945 6 6

7. Emergence of antibiotic resistance
Antibiotic resistance threatens ability to control infection
The time it takes for bacteria to develop resistance is decreasing.
This slide shows that the time between discovery of a new antibiotic and development of resistance has become much shorter over the last 40 years.
Start of line = time of antibiotic discovery, End of line = when resistance reported
5. Pray LA Insight Pharma Reports 2008, in Looke D ‘The Real Threat of Antibiotic Resistance’ 2012 7

8. Resistance spreads rapidly
Once resistance develops it can spread rapidly.
This graph from the Center of Disease Control in the US demonstrates how quickly resistant strains of MRSA, VRE and fluoroquinolone resistant Pseudomonas aeruginosa have spread.
6. Centers for Disease Control and Prevention 8

9. Impact of resistance: real people are affected
Increased morbidity/mortality
Evidence across many pathogens
Pan drug resistant infections
Now being encountered
Increased costs
$18-29,000 US/patient
Excess length of stay 6.4 – 12.7 days/patient
Glen’s story
Patients infected with resistant pathogens are more likely to have treatment failures, recurrent infections and delayed recovery.
There is also a significant cost related to the treatment of resistant infections.
Hint for presenters:
You can embed the video link into the presentation, so viewers can watch this 5 minute video.
The website of the Infectious Diseases Society of America has a “patient stories” page.
Ask the audience to think about patients they have cared for that have had a resistant infection. What was it like for the patient? The family? The team?
7. Glen’s story access at
8. Magiorakos, A. P., Srinivasan, A et al Clinical Infectious Diseases 2012; 18 (3);
9. Roberts RR et al. Clinical Infectious Diseases 2009; 49: 9 9

10. Antibiotic resistance: a global problem…
Key findings:
Very high rates of resistance observed for common bacteria that cause health care associated and community acquired infections (for example urinary tract, pneumonia) in all WHO regions.
Significant gaps in surveillance.
Urgent need to strengthen collaboration on global surveillance as the foundation of global strategies to address antimicrobial resistance (AMR).
In July 2013 the World Health Organization (WHO) released this report in an attempt to obtain a picture of the magnitude of the problem of AMR and the current state of surveillance efforts globally.
Major findings of the report are noted in this slide.
The full report is available from the WHO website.
10. World Health Organization Antimicrobial Resistance: Global Report on surveillance.
Last accessed 21/9/14

11. ...a problem in our region
High prevalence of drug resistance reported in clinically important pathogens including serious hospital acquired skin infections.
For example
prevalence rates of 77.6% and 74.1% of methicillin-resistant S. aureus reported in Republic of Korea and Vietnam respectively.
prevalence rates of 68–90% of gonorrhoea infections with reduced susceptibility and resistance to quinolones reported in Japan, Malaysia and Singapore.
Resistance is high in our region.
11. WHO Action agenda for antimicrobial resistance in the Western Pacific Region. Access at: last accessed 8 September 2015

12. Antibiotic resistance in our region
Korea
ECOL: 37%
KPNE: 40%
China*
ECOL: 54%
KPNE: 41%
Japan†
ECOL: 17%
KPNE: 11%
Hong Kong
ECOL: 46%
KPNE: 23%
India
ECOL: 78%
KPNE: 64%
Taiwan
ECOL: 91%
KPNE: 75%
Thailand*
ECOL: 55%
KPNE: 50%
Philippines
ECOL: 47%
KPNE: 23%
Singapore
ECOL: 21%
KPNE: 32%
Malaysia
ECOL: 36%
KPNE: 45%
Indonesia
ECOL: 71%
KPNE: 64%
This slide clearly demonstrates the problem of resistance in our region.
Many countries have high levels of resistant Gram negative bacilli such as E Coli and Klebsiella species that cause common infections such as urinary tract infections and pneumonia.
This slide depicts the proportion of extended-spectrum β-lactamase (ESBL) producing gram negative bacilli for pathogens E Coli (ECOL) and Klebsiella pneumoniae (KPNE) in the Asia Pacific region.
In some countries the proportion of E Coli infections that are ESBL producing is greater than 50%.
The presence of ESBLs is indicative of multi-resistance.
In Australia, 12% of E Coli infections are ESBL producing organisms.
Slide - courtesy of Prof John Turnidge.
Australia
ECOL: 12%
KPNE: 15%
Resistance (%ESBL) in the Asia Pacific region
New Zealand
ECOL: 11%
KPNE: 10%
12. Mendes et al., Antimicrob. Agents Chemother Xiao et al, Drug Resist Updat, 2011 (2009 data)
14. Chong et al., EJCMID, 2011 (2009 data) 12

13. …and a problem here in Australia
As indicated in the previous slide, there are cases reported in Australia of infections with multi resistant organisms that are difficult or unable to be treated with antibiotics.
This includes multi-resistant Gram negative bacteria (MRGN).
Although rates are lower in Australia than in the United States, Southern Europe and much of Asia, Gram negative resistance in Australia is rising.
The problem has gained some public attention; recently cases of MRGN in Victoria were discussed in the media.
Australian context:
In the paper “The Red Plague” (13) the authors discuss some of the potential consequences of Gram negative resistance, including:
the need to treat previously simple infections with intravenous instead of oral antimicrobial therapy
the need to treat severe community-acquired sepsis with antibiotics of last resort upfront
a growing ineffectiveness of surgical antibiotic prophylaxis.
Other authors have also highlighted the growing prevalence and challenges of MRGN. While currently rare in Australia, they have caused significant outbreaks.
Harris and others highlight the importance of a multifaceted approach to addressing MRGN, particularly in the absence of effective antibiotics. Such an approach includes widespread implementation of antimicrobial stewardship and improved infection control practices.
In Australia, recommendations for the management of MRGN can be accessed via the web site of the Australian Commission on Safety and Quality in Health Care:
15 Looke DF, Gottlieb T, Jones CA, Paterson DL Med J Aust Mar 18;198(5):243-.
16. Harris P, Paterson D, Rogers B Med J Aust Facing the challenge of multidrug-resistant gram-negative bacilli in Australia. Mar 16;202(5):243-7. 13

14. Antibiotic resistance locally What is happening in our health service
Which infections are we seeing?
What are our susceptibility and resistance patterns ?
[Insert hospital data]
[Numbers of cases]
[Examples of cases]
Locally, surveillance data enables understanding of local resistance patterns and helps to guide policies around antibiotic use locally.
Note to presenters:
Users should insert local hospital data into this slide. If a hospital antibiogram is available, use that. If not, give examples of infections from resistant pathogens that have occurred. Examples might include: Central line associated bacteraemia, catheter associated urinary tract infections, or surgical site infections. Consider the audience and the information that will be most relevant.
Consider also including information about the negative outcomes for patients from resistant infections, such as increased length of stay.
Consider asking the audience before revealing the answers:
What are the common infections seen here?
What are our local susceptibility and resistance patterns? 14

15. The link between use and resistance
Countries with high penicillin consumption also have high rates of penicillin resistance in pneumococci
Occurrence of penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) versus outpatient use of penicillins in 17 European countries. 
There is a link between antibiotic use and antibiotic resistance, demonstrated in this slide.
Image shows the occurrence of penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) plotted against outpatient use of penicillins in 17 European countries. Note that Streptococcus pneumoniae is a Gram positive.
The graph clearly demonstrates the relationship of usage with development of penicillin resistance – as usage has increased so has resistance.
DID = defined daily doses per 1,000 inhabitants (from source)
Note to presenters: PNSP is not a recognised abbreviation in Australia, abbreviation is taken from the source.
17. van de Sande-Bruinsma N et al. Emerging Infectious Diseases 2008; 14(11): 15 15

16. Antibiotic usage varies
Within the country there is variation in consumption of antibiotics, not easily accounted for by case-mix. .
Monitoring antibiotic usage is a fundamental component of antimicrobial stewardship. It enables targeting of interventions to improve antimicrobial prescribing.
The Australian Commission on Safety and Quality in Health Care is working with the National Antimicrobial Utilisation Surveillance Program (NAUSP) to enhance volume-based monitoring of use in hospitals from all Australian states and territories.
This figure, taken from the 2014 NAUSP report, shows aggregated annual total-hospital antibacterial usage rates by state/jurisdiction for NAUSP contributors for There are variations in usage rates for a number of the antimicrobials – in this figure there is apparent variation between a number of antibiotic groups, including those broader spectrum agents
129 contributing hospitals.
axis label: Antimicrobial usage rate DDD per 1000 OBDs = Defined Daily Doses per 1000 Occupied Bed Days.
annual average usage rates for individual hospitals in 2014 ranged from 330 to 2040 DDDs per 1000 OBDs.
median annual usage rate for individual hospitals was 907 DDDs per 1000 OBDs.
Note to presenters:
Differences in antimicrobial usage rates within and between hospital services are complex and multifactorial, and may reflect differences in case-mix; microbial resistance rates; implementation of AMS programs; and changes in hospital formularies, policies and regulation. However, monitoring usage provides hospitals with the opportunity to identify changes in usage that might be linked to the development of antibiotic resistance and adjust their AMS strategies accordingly.
Overall antimicrobial usage rates (N=129) NAUSP 2014 *
Antimicrobial use in Australian hospitals: 2014 annual report of the National Antimicrobial Utilisation Surveillance Program 16 16

17. Antibiotic usage varies
Between hospitals consumption also varies. Annual carbapenem usage by AIHW* peer group (FY )
There is also inter-hospital variation not easily accounted for by case-mix.
For example, this slide from NAUSP shows variation in carbapenem use in hospitals by AIHW peer group.
The Y-axis label for each graph shows: Antimicrobial usage rate DDD per 1000 OBDs = Defined Daily Doses per 1000 Occupied Bed Days.
Carbapenems (predominantly meropenem) are broad-spectrum agents reserved for treatment of infections caused by multidrug-resistant organisms. They are the last line of treatment for serious infections caused by multi-resistant E.coli, Klebsiella species and other Enterobacteriaceae.
Gram negative bacteria known as carbapenem resistant Enterobacteriaceae (CRE) that are resistant to most types of antibiotics, including carbapenems are now emerging, leaving us with fewer alternative treatment options.
Note for presenters: As expected, usage rates were highest in principal referral hospitals, followed by large and medium public acute hospitals (Figure 23). Use in small hospitals was minimal, which is expected, as patients requiring these agents would generally be expected to be managed in larger hospitals.
*Australian Institute of Health and Welfare
19. Data source: National Antimicrobial Utilisation Surveillance Program (NAUSP) – unpublished data

18. Antibiotic use in Australian Hospitals
30-40% of hospitalised patients are prescribed antibiotics20,21
The 2014 NAPS* Report indicates that around one quarter of antibiotics prescribed in Australian hospitals are prescribed inappropriately21
Australian hospitals dispense higher volumes of antibiotics than some other countries22
*Hospitals that participate in NAPS are provided with data on the appropriateness of their own prescribing patterns for local quality improvement.
A large proportion of hospitalised patients are prescribed antibiotics, though precise estimates vary.
The National Antimicrobial Prescribing Survey (NAPS) is a standardised auditing tool designed to assist healthcare facilities to assess quality of antimicrobial prescribing.
NAPS had 248 hospitals participate in the 2014 survey, if you aren’t a participant, join up now.
Results of the 2014 NAPS survey showed around one quarter (23%) of antibiotic prescriptions were deemed to be inappropriate. Inappropriate use related mainly to use of broad spectrum antibiotics or incorrect duration of treatment.
NAUSP data from 2014 show that Australian hospitals dispense higher volumes of antibiotics than the Netherlands and Sweden, and are on par with Denmark. (Caution needs to be applied in interpreting these figures due to differences including variation in data collection. There may also be variation in access, severity, referral patterns and inpatient practices).
Note to presenters: The documents referenced on this slide can be accessed via the web site of the Australian Commission on Safety and Quality in Health Care (the Commission). See also the reference list which can be downloaded from the Commission website, then printed and used as a handout.
20. Duguid M, Cruickshank M (eds). Antimicrobial Stewardship in Australian Hospitals.  Sydney: ACSQHC, 2011
21. Australian Commission on Safety and Quality in Health Care (2015). Antimicrobial prescribing practice in Australian hospitals: results of the 2014 National Antimicrobial Prescribing Survey, ACSQHC, Sydney.
22. Antimicrobial use in Australian hospitals: 2014 report of the National Antimicrobial Utilisation Surveillance Program

19. What is inappropriate use ?
Inappropriate use includes:
Using broad-spectrum antibiotics (such as third generation cephalosporins, carbapenems) when narrow-spectrum antibiotics are effective
Prescribing too low or too high a dose of antibiotic
Not prescribing according to microbiology results
Continuing treatment for longer than necessary
Omitting doses or delayed administration.
Top reasons for inappropriate use – NAPS 2014
With inappropriate antibiotic usage recognised as a key driver of resistance and few new drugs in the pipeline, it is apparent that interventions to promote appropriate use are an essential component of an overall strategy to reduce antibiotic resistance.
In human health, results from the National Antimicrobial Prescribing Survey 2014, a survey of prescribing appropriateness from 248 hospitals across Australia, suggest that up to one quarter of hospital antibiotic prescriptions in Australia are inappropriate. Full details about this survey and the results can be located on the web site of the Australian Commission on Safety and Quality in Health Care.
Note for presenters: this slide has animation effects. Each item on the list will be revealed with a click. Consider asking the audience for examples of inappropriate use, before revealing the list.
This slides gives some examples of inappropriate use, including:
Unnecessary prescription of antibiotics, such as for viral infections (colds) or for prolonged prophylaxis
Use of broad-spectrum antibiotics (such as third generation cephalosporins, carbapenems) when narrow-spectrum antibiotics are effective
Inadequate treatment. For example, the antibiotic is ineffective or the dose is too low leading to treatment failure
Prescribing too high a dose, causing toxicity
Continuing treatment for longer than necessary because courses are not time limited or cancelled
Not prescribing according to microbiology results
Omitting doses or delays in administration
Prescribing intravenous agents when an oral agent is known to be as effective and clinically safe
Not taking antibiotics as prescribed – this may include stopping and starting therapy, continuing for shorter or longer than prescribed, saving antibiotics for another illness, or giving “leftover” prescriptions or antibiotics to others who are sick.

20. Adding to the problem … Antibiotics are a limited resource
The dwindling development of antibiotics…
number of US FDA Antibiotic approvals23
Few new antibiotics
majority developed pre 1970
3 new classes in 20 years
Global recognition that:
new antibiotics are urgently required
need to conserve what we have now 24
To add to the problem of increased resistance and consumption, few new antibiotics are being developed.
only three novel antibiotic classes have been developed in the last 20 years.
although new antibiotics are urgently needed it is expected that few will be developed in the next 10 years.
there is a need to conserve what we have.
23: Adapted from Spellberg B et al. The epidemic of antibiotic resistant infections: A call to action for the medical community from the Infectious Diseases Society of America. Clin Inf Dis 2008;48:155-64
24. Spellberg B New antibiotic development: barriers and opportunities in APUA Clinical Newsletter 2012; 30(1):8-10

21. Antibiotic usage in our health service
Insert local usage data if available
Include information about
Contributions to National Antimicrobial Usage Surveillance Program (NAUSP)
Note: This information should be available from the Pharmacy Department or local pharmacy contractor/supply service. If comprehensive data is not readily available, consider choosing one broad spectrum agent as an example.
Consider asking the audience:
What do you think are the higher amounts of antimicrobials used in our health service? 21

22. What about antibiotic appropriateness in our health service?
Insert local prescribing data including
Participation in the National Antimicrobial Prescribing Survey, results and trends over time if relevant.
Note: Ask the audience – Do these results surprise you? How do you think your department/unit results compare to the hospital-wide results? 22

23. Seven objectives focused on Awareness, education
The National Antimicrobial Resistance (AMR) Strategy25 Responding to the threat of AMR
Seven objectives focused on
Awareness, education
Antimicrobial stewardship
Surveillance
Infection prevention and control
International management
Research and development
Governance
A global action plan developed by WHO to tackle the growing problem of resistance to antibiotics and other antimicrobial medicines was endorsed at the Sixty-eighth World Health Assembly in May 2015.
One of the key objectives of the global plan is to improve awareness and understanding of antimicrobial resistance through effective communication, education and training. Antibiotic Awareness Week is one way to achieve this.
The Australian National AMR strategy was released in June 2015, and reflects the key action areas identified in the WHO global action plan.
25. Commonwealth of Australia. National Antimicrobial Resistance Strategy Access at:

24. Addressing antibiotic resistance is everybody’s business.
Addressing antibiotic resistance: a multidisciplinary, comprehensive approach
Prevent and manage infections
Infection prevention and control
Includes hand hygiene, standard and transmission-based precautions, environmental cleaning.
Prolong effectiveness of existing antibiotics
Antimicrobial stewardship
Addressing antibiotic resistance is everybody’s business.

25. Antimicrobial stewardship (AMS)
Principles:
promote best clinical outcome for the treatment or prevention of infection
minimal toxicity to the patient
minimal impact on resistance and other adverse events
timely and optimal selection, dose and duration of an antimicrobial.
Requires team work at all levels:
“everybody's business"
executive and clinical leadership
clinical team (doctors, nurses, pharmacists, allied health)
consumers.
Antibiotics are used every day in every hospital ward or unit.
Everyone: consumers and patients, doctors, nurses, pharmacists, and other prescribers, all have a part to play.
Nathwani D and Sneddon J. Practical Guide to Antimicrobial Stewardship.
Access at 25

26. Essential strategies for effective AMS
This publication Antimicrobial Stewardship in Australian Hospitals was published by the Australian Commission on Safety and Quality in Health Care in 2011.
It contains the recommendations on which accreditation criteria for AMS are based.
The book incorporates available evidence and information regarding strategies for implementing an AMS program.

27. NSQHS Standards, Standard 3: Antimicrobial Stewardship Criterion
Actions required:
3.14.1
An AMS program is in place
3.14.2
The clinical workforce prescribing antimicrobials have access to endorsed Therapeutic Guidelines on antibiotic usage
3.14.3
Monitoring of antimicrobial usage & resistance is undertaken
3.14.4
Action is taken to improve effectiveness of your AMS program
There is an Antimicrobial Stewardship Criterion that forms part of Standard 3.
All hospitals and day procedure services are required to:
have an AMS program in place
provide access to endorsed Therapeutic Guidelines on antibiotic usage
monitor their antimicrobial usage and resistance, and
take action to improve the effectiveness of their AMS program.
Participation in surveillance programs supports compliance with Standard 3.
27. National Safety & Quality Health Service Standards .Access at 27

28. Clinical Care Standard for AMS What role do you play?
Nine statements describing best practice for managing a patient who has, or is suspected of having a bacterial infection, regardless of setting.
For consumers: describes the care they can expect to receive
For clinicians: provides support in the delivery of care the patient is expecting
For health services: systems are in place to support clinicians in providing the care that is expected by the patient
The AMS Clinical Care Standard highlights the expected care to be given by all clinicians, and that all patients can expect to receive, regardless of setting.
It highlights the fact that like infection prevention and control, careful antibiotic use is “everybody's business“.
Antibiotic prescribing and use is not only for physicians and other prescribers, because antibiotics are used every day in every hospital ward or unit.
Everyone - Consumers and patients, doctors, nurses, pharmacists, and other prescribers, all have a part to play.
28. Australian Commission on Safety and Quality in Health Care. Antimicrobial Stewardship Clinical Care Standard. Access at

29. Antimicrobial Use and Resistance in Australia
The AURA Project will establish a national antimicrobial usage and resistance surveillance system by June 2016.
Working with existing programs, such as NAPS and NAUSP, will enhance capacity for surveillance and build new systems such as the National Alert System for Critical Antimicrobial Resistances (NASCAR).
The key objective is to increase access to data for action against AMR.
Funded by the Australian Government Department of Health.
At a local level, monitoring and analysis of antibiotic usage is critical to understanding antibiotic resistance and measuring the effects of
stewardship interventions.
At a national level, the Australian Commission on Safety and Quality in Health Care is developing a National Antimicrobial Usage and Resistance Surveillance System, known as AURA. This system will enable national data to be gathered, analysed, and reported, to enable a better understanding of AMR and the capacity to develop response and prevention strategies.
Hint to presenters:
If your hospital contributes to national data collection, you could highlight what this means in terms of the “bigger picture” of addressing AMR:
Monitoring antibiotic use and resistance in our hospital helps to identify priorities and opportunities for improvement. By contributing to data collections such as the National Antimicrobial Usage Surveillance Program (NAUSP) and the National Antimicrobial Prescribing Survey (NAPS), our hospital is also helping to provide better understanding of practices and variation nationally, that may impact the emergence of antibiotic resistance, and contribute to the goals and objectives highlighted in the National AMR Strategy.

30. Antimicrobial stewardship in our hospital
Multidisciplinary, team approach
Local roles and responsibilities
Medicine, nursing, pharmacy
Consumer participation
Executive and clinical leaders
Local processes for stewardship
Include local processes for
seeking ID/micro consults
guideline and formulary information
pharmacy advice
contacts
other relevant information.
Note:
As well as the information here, consider inserting additional slides, with details of current activities relevant to stewardship - for example processes for audit and feedback, or special projects being undertaken to include antibiotic prescribing in specific settings.

31. Our Health service tools and activities to promote appropriate use of antibiotics
Responsible committees
e.g. infection control, drug and therapeutics committees
AMS team to coordinate activity
Education
Local prescribing guidelines
Therapeutic Guidelines: Antibiotic
AMS Clinical Care Standard
Policy
Formulary with restrictions and approval
Access to expert prescribing advice
ID, micro, pharmacy
Monitoring, audit and feedback
appropriateness, usage, indicators
Who to contact?
Note: Green text provides suggestions for information to be included.
29. Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2014. 31

32. Therapeutic Guidelines: Antibiotic A quick note…
Check hospital intranet
Current Version 15
released November 2014
Learn more
click ‘Products’, then ‘Antibiotic’
summary of new information and major changes for version 15:
Prescribers should always confirm that they are using the most current version of guidelines.
Presenters: consider using this as an opportunity to highlight local processes for guideline revision.

33. Antibiotic Awareness Week 2015
Coordinated by The Australian Commission on Safety and Quality in Health Care
National working group, “One Health” focus:
Australian Government Department of Agriculture and Water Resources
Australian Government Department of Health
State and Territory Health representatives
NPS MedicineWise
Australian Veterinary Association.
Supported by:
Australasian College for Infection Prevention and Control
Australasian Society for Infectious Diseases
Australian Society for Antimicrobials
Society of Hospital Pharmacists of Australia.
This is the fourth year that the Commission has partnered with key organisations to promote Antibiotic Awareness Week in Australia.
The involved organisations and partners are listed on the slide.
The campaign reflects the “One health” approach outlined in the Global Action plan and Australia’s National AMR strategy.
The One Health approach involves cross-sector collaboration between medical and health professions, veterinarians, farmers, food producers, and other experts. 33

34. Australian Commission on Safety and Quality in Health Care Antibiotics
Australian Commission on Safety and Quality in Health Care Antibiotics. Handle with Care.
How can we use antibiotics appropriately? The AMS Clinical Care Standard outlines evidenced based approaches for using antibiotics with care:
Initiate urgent treatment of life threatening conditions
Obtain samples for culture before starting therapy
Prescribe in accordance with the latest edition of Therapeutic Guidelines: Antibiotic or hospital guidelines that align with the Therapeutic Guidelines:Antibiotic
Educate and involve patients and carers and ensure they know how to use antibiotics appropriately
Document the prescription, reason for the antibiotic, and the review date. This enables timely review by the team if required, and helps ensure duration of therapy does not exceed recommendations. It also enables de-escalation if required.
Review therapy and seek advice from clinical microbiology or infectious diseases physician early for complex cases
Convert to targeted therapy when the pathogen and its susceptibilities are known. Consult a clinical pharmacist for advice on optimising the antibiotic doses. Change from IV to oral therapy where possible.
More information about the Clinical Care Standard for AMS can be found on the web site of the Australian Commission on Safety and Quality in Health Care.
The AMS Clinical Care Standard outlines evidenced-based approaches for using antibiotics with care. Access at 34

35. Antibiotic Awareness Week What is happening in our health service ?
Local activities, contacts
Include information about local activities.

36. Fight antibiotic resistance: take the pledge
NPS MedicineWise is asking consumers and health professionals to take the pledge to fight antibiotic resistance
Health professionals are encouraged to have the sometimes difficult conversations with patients when antibiotics are not appropriate
Visit nps.org.au/aaw to download resources to use throughout AAW
Join the conversation - or hashtag #AntibioticResistance on social media
NPS MedicineWise is encouraging consumers and health professionals to pledge to join the fight against antibiotic resistance.
An interactive application on the NPS MedicineWise web site allows people to pledge their commitment to the MINDME creed and add the suburb of their workplace to the national map of antibiotic resistance fighters.
After making the pledge, individuals will be able to generate a personalised antibiotic resistance fighter certificate to print and display or share with social media networks.
The pledge is available online along with other resources, visit

37. World Health Organization (WHO) First World Antibiotic Awareness Week Antibiotics: Handle with Care
Antibiotics are a precious resource and should be preserved.
Aim of World Antibiotic Awareness Week:
increase awareness of global antibiotic resistance
encourage best practices among general public, health workers and policy makers to avoid further emergence and spread of antibiotic resistance.
resources and more information available:
WHO international
Who Western Pacific Regional Office
2015 marks the First World Antibiotic Awareness Week. Countries around the world are participating, demonstrating the significance of this issue globally.

38. A global effort
Canada: Healthy Canadians Antibiotic
United States: Get Smart About Antibiotics
Europe: Antibiotic Awareness Day
Examples of some of the organisations and countries observing Antibiotic Awareness Week; in Europe Antibiotic Awareness Day has been observed annually on 18 November for some years.

39. Join the conversation
“Never underestimate the importance of consumer groups and civil society in combating antimicrobial resistance. They are important movers, shakers, and front-line players, especially in this age of social media.”
Dr Margaret Chan30
Monday 16 November
Australian Antibiotic Awareness Week
#ABxAus
Wednesday 18 November
A global Twitter chat involving partner countries
Organisations and experts participating
#AntibioticResistance
30. Dr Margaret Chan, Keynote address at the conference on Combating antimicrobial resistance: time for action Copenhagen, Denmark 14 March last accessed 22/9/14

40. Remember… Antibiotics are a limited, precious resource
Antibiotics are a precious resource that could be lost.
Antibiotic resistance is happening now – it is a worldwide problem that affects human and animal health.
Antibiotic resistance happens when bacteria stops an antibiotic from working effectively – meaning some infections may be impossible to treat.
Misuse of antibiotics contributes to antibiotic resistance.
Few new antibiotics are being developed to help solve this problem.
To preserve the miracle of antibiotics, whenever they are used, antibiotics must be used with care.

41. Acknowledgements
Australian Commission on Safety and Quality in Health Care
Antibiotic Awareness Week working group members
AMS Jurisdictional Network
AMS Advisory Committee
Australian Group on Antimicrobial Resistance
National Antimicrobial Utilisation Surveillance Program
National Centre for Antimicrobial Stewardship
European Centre for Disease Prevention and Control
World Health Organization (WHO)
References available at
This presentation is intended to be used by health professionals, and reasonable care has been taken to ensure that the information is correct at the date of creation. It is intended to be used in its original version.
The original version along with a complete list of references can be downloaded from the Commission web page: