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

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

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

Prudent antibiotic prescribing: a UK initiatives http://antibioticguardian.com/

“ 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

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’

Follow local antibiotic prescribing guidance

Workspaces

MICROGUIDE Web Browser

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)

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”

Duration of antibiotics - IV “Treatment with IV antibiotics should not continue beyond 48-72 hours unless recommended by local guideline or microbiologist” “Rationale for continuing IV should be clearly documented with a new review date/duration”

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

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

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: https://fingertips.phe.org.uk/profile/amr-local-indicators

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

All 6 care elements must be completed to achieve 100% compliance 4 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

References/CPD PHE Antimicrobial Resistance- Resources Handbook, Mar 2017 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/605967/PHE_AMR_resource_handbook.pdf WHO Antimicrobial Stewardship: competency-based approach (open learning) https://openwho.org/courses/AMR-competency UK Massive Open Online Course (MOOC) on Antimicrobial Stewardship https://www.futurelearn.com/courses/antimicrobial-stewardship