Antibiotic campaign resources 2018/19

This year’s antibiotic campaign started on Monday 8 October.

Add messages and resources to your practice or pharmacy website and Twitter account.

Tweet Antibiotic Guardian messages #AntibioticGuardian

Become an Antibiotic Guardian each year. Print and display your certificate.

Send pictures of your antibiotic campaign display to Antibiotic Guardian Chair, Dr Diane Ashiru-Oredope: espaur@phe.gov.uk 

 

National posters and leaflets are available from Public Health England via their resource centre

Tweet at #KeepAntibioticsWorking

 

Add a banner to your e-mail signature:

 

Right click your chosen image and copy. In ‘Outlook’, open signature

(file, options, mail, compose messages, create or modify signatures, e-mail signature tab).

Paste the image into the dialogue box. Re-size as necessary.

 

Videos for patient waiting areas

See National Digital Screens

 

Our top tips

Antibiotic Top Tips

 

For primary care prescribers

Patient diaglogue

Factsheet for primary care prescribers

A GP guide to antimicrobial resistance YouTube video

Instructions on how to issue Treating Your Infection leaflets via SystmOne TTP and EMIS

Advice for patients you can add to ‘book appointment’ or ‘repeat prescription’ page on online systems

 

 

For secondary care prescribers

EAAD factsheet for hospital prescribers

EAAD checklist for prescribers in hospitals and other healthcare settings

Advocacy poster for hospitals

Start smart then focus

 

For nurses

Antimicrobial resistance from Royal College of Nursing

Poster for nurses in hospitals and other healthcare settings

Posters for nurses and midwives to display from PHE

Quiz

 

TARGET leaflets and forms

A range of leaflets for patients is available from the Royal College of General Practitioners TARGET Antibiotics Toolkit page.

One can be used during consultations with women who are experiencing non-complicated urinary tract infections, when the clinician feels that the patient does not require an antibiotic prescription:

TARGET urinary tract infection information leaflet v19

The leaflet is available in different languages from the TARGET website

 

For care home staff

Form to complete and fax to GP if an older resident has a suspected urinary tract infection:

Management of UTIs in nursing homes form  (minor changes to website addresses 18.9.2018)

 

For dentists

This toolkit provides a set of resources to help promote the most appropriate use of antibiotics in dental care.

 

For pharmacists and pharmacy technicians

Royal Pharmaceutical Society resources, including the pharmacy contribution to antimicrobial stewardship.

 

For hospital pharmacists and laboratory staff

Quiz

 

For schools and other childcare facilities

A practical guide for staff on managing cases of infectious diseases in schools and other childcare settings.

 

Videos

Keep antibiotics working

When it comes to antibiotics take your doctor’s advice

Catch – film about a fictional father and daughter in a future world when antibiotics are useless

True Life Stories: From Patients to Doctors

 

Handwashing

A survey by the Royal Pharmaceutical Society has found that 84% of British adults don’t wash their hands for long enough. A guide on how to wash hands is available from their website.

 

Some headlines from NICE

Do not issue repeat prescriptions for antimicrobials unless patient has a particular clinical need. Avoid issuing repeat prescriptions for longer than 6 months without review. Monitor patients to reduce risk of side effects and check if antimicrobial is still needed (NG15).

Self-care includes resting, drinking plenty of fluids and taking over-the-counter preparations for symptom relief if necessary. Promote community pharmacies as easily accessible places to obtain advice on managing self-limiting infections. Give people information on the importance of hand-washing (NG63).

 

Some evidence

What treatments are effective for common cold in adults and children?

BMJ article about what works and what doesn’t.

Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: secondary analysis from a multicentre prospective cohort study

An English prospective cohort study looked at 8,320 children presenting in primary care with acute cough/other respiratory symptoms. A secondary analysis shows modelling used to estimate the effect of antibiotic prescribing on adverse outcomes within 30 days (subsequent hospitalisations and re-consultation for deterioration), 65 (0.8%) children were hospitalised and 350 (4%) re-consulted for deterioration. Immediate and delayed antibiotics were prescribed to 2,313 (28%) and 771 (9%), respectively. Compared with no antibiotics, there was no clear evidence that antibiotics reduced hospitalisations (immediate antibiotic RR 0.83, 95%CI 0.47 to 1.45; delayed RR 0.70, 95%CI 0.26 to 1.90, overall P=0.44). There was evidence that delayed antibiotics reduced re-consultations for deterioration (immediate RR 0.82, 95%CI 0.65 to 1.07; delayed RR 0.55, 95%CI 0.34 to 0.88, overall P = 0.024).

Does shared decision-making reduce antibiotic prescribing in primary care?

Data from electronic health records of 8,192 adult patients in general practices in Holland were used to assess illness episodes for acute cough, acute rhinosinusitis and urinary tract infection. In practices where more shared decision making took place, GPs prescribed fewer antibiotics for patients < 40 years in situations where antibiotics could be considered according to clinical guidelines.

For people with respiratory infection, how do delayed compare with immediate or no antibiotic prescriptions?

Compared with immediate antibiotics, delayed antibiotics for people with respiratory infection led to a decrease in antibiotic use (on average, 348 vs 930 per 1,000 people). There were no apparent differences between groups in cough, patient satisfaction, or rates of re‐consultation. Compared with no antibiotic, delayed antibiotic resulted in an increase in antibiotic use (on average, 287 vs 137 per 1000 people). However, more people were satisfied with delayed antibiotic (on average, 875 vs 824 per 100 people). Results show no apparent differences between groups in pain, fever, or antibiotic‐related adverse events.

Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis

A review found that antimicrobial stewardship programmes alone may reduce overall antibiotic resistance by 19% (incidence ratio [IR] 0.81, 95% confidence interval [CI] 0.67 to 0.97). Combining stewardship programmes with procedures for controlling infection appears to reduce antibiotic resistance by 31% (IR 0.69, 95% CI 0.54 to 0.88). Combining stewardship programmes with hand-hygiene appears to be the most effective combination, reducing antibiotic resistance by 66% (IR 0.34, 95% CI 0.21 to 0.54). These programmes also reduced the incidence of multi-drug resistant gram-negative bacteria and extended spectrum beta-lactamase producing gram-negative bacteria such as E. coli.

 

Behaviour change and antibiotic prescribing in healthcare settings – literature review and behavioural analysis

Literature review of key behaviours which support antibiotic stewardship. Interventions included online pledges for parents; making delayed prescriptions the default for respiratory infections; changing design of hospital prescription charts; and enhanced feedback on prescribing behaviours.

 

Stemming the Tide of Antibiotic Resistance (STAR)

An educational programme used in general practice – included feedback on prescribing data and case scenarios.

 

Antibiotic prescription strategies and adverse outcome for uncomplicated lower respiratory tract infections: prospective cough complication cohort (3C) study

A UK general practice cohort study looked at lower respiratory tract infection in 28,883 patients aged 16 and over.  104 (0.4%) were referred to hospital for radiographic investigation or admission, or both on the day of the index consultation, or were admitted with cancer. Of the remaining 28 779, subsequent hospital admission or death occurred in 26/7332 (0.3%) after no antibiotic prescription: 156/17 628 (0.9%) after prescription for immediate antibiotics; and 14/3819 (0.4%) after a prescription for delayed antibiotics. Analysis found no reduction in hospital admission and death after immediate antibiotics and a non-significant reduction with delayed antibiotics. Re-consultation for new, worsening, or non-resolving symptoms was common (1443/7332 (19.7%), 4455/17 628 (25.3%), and 538/3819 (14.1%), respectively) and was significantly reduced by delayed antibiotics but not by immediate antibiotics. The authors concluded that if clinicians are considering antibiotics, a delayed prescription may be preferable to an immediate prescription.

An accompanying editorial notes:

“The most important findings were that serious adverse events such as death or hospital admission are rare in people with acute cough and that an immediate antibiotic prescription is not associated with a significantly reduced risk.

This study adds to others showing that not offering an immediate prescription for antibiotics to people with common uncomplicated acute respiratory infections is a low risk strategy”

 

Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial

Strategies of no prescription or delayed antibiotic prescription resulted in fewer than 40% of patients using antibiotics, and are associated with less strong beliefs in antibiotics, and similar symptomatic outcomes to immediate prescription. If clear advice is given to patients, there is probably little to choose between the different strategies of delayed prescription.

 

Antibiotic prescription strategies for acute sore throat: a prospective observational cohort study

Cohort of 12,829 adults presenting with sore throat (≤2 weeks duration) in primary care – suppurative complications are not common in primary care and most are not serious. The risks of suppurative complications or re-consultation in adults are reduced by antibiotics, but not as much as the trial evidence suggests. In most cases, no antibiotic is needed, but a delayed prescription strategy is likely to provide similar benefits to an immediate antibiotic prescription.

 

Education targeted at both parents and GPs reduces antibiotic prescribing for children

Systematic review of 12 educational interventions found that interventions were associated with lower rates of antibiotic prescribing vs usual care (odds ratio 0.63, confidence interval 0.50 to 0.81). UK study targeted both clinicians and parents through use of an interactive booklet during the consultation. In the index consultation, antibiotics were prescribed 19.5% in the intervention group and 40.8% in the control group.

 

Some national learning resources

WHO Antimicrobial Stewardship: a competency based approach.

Health Education England e-learning on antimicrobial resistance.

Target training resources. These include antibiotic resistance, urinary tract infections, sexual health, skin.

Online courses at Future Learn. These include ones about antimicrobial resistance.

Education and training section in Antimicrobial Resistance Resource Handbook. These include infection control and antimicrobial stewardship.

NECS e-learning: antibiotic prescribing and antimicrobial stewardship in primary care.

For the pharmacy workforce (CPPE). These include antibacterial resistance, antibacterials.

e-Bug has learning resources for children and young people.

TED-Ed – What causes antibiotic resistance?

 

Other resources

British Society for Antimicrobial Chemotherapy

(includes an e-book: Antimicrobial stewardship: from principles to practice)

UK One Health Report

Preventing healthcare associated Gram-negative bacterial bloodstream infections

PHE Antimicrobial Resistance AMR Toolkit for Public Engagement April 2017

NICE

Clinical Knowledge Summaries

Antibiotic Research UK

UK 5-year antimicrobial resistance strategy 2013-2018

What vets are doing to tackle antibiotic resistance

Resource Toolkit

Green Book

Quiz for healthcare staff

 

Some data on antibiotic usage

Quality premium antibiotic dashboard

ESPAUR report – English surveillance

Fingertips – AMR local indicators

PrescQIPP – see section on antimicrobial stewardship in the Data Hub

 

Campaigns

European Antibiotic Awareness Day: 18 November

WHO World Antibiotic Awareness  Week 12 – 18 November