NICE NEW Antimicrobial Stewardship Guidelines

The UK now has national guidelines regarding antimicrobial stewardship, just like the USA and Australia. The guidelines recommend antimicrobial stewardship activities across all aspects of health care and encourage research into new antibiotics. The guideline also provides useful advice on how to deal with patients who inappropriately request antibiotics – see below for some excerpts- 

The guideline suggests that prescribers should take time to discuss with the patient and/or their family members or carers (as appropriate):

  • the likely nature of the condition
  • why prescribing an antimicrobial may not be the best option
  • alternative options to prescribing an antimicrobial
  • their views on antimicrobials, taking into account their priorities or concerns for their current illness and whether they want or expect an antimicrobial
  • the benefits and harms of immediate antimicrobial prescribing
  • what they should do if their condition deteriorates (safety netting advice) or they have problems as a result of treatment
  • whether they need any written information about their medicines and any possible outcomes.

If immediate antimicrobial prescribing is not the most appropriate option, discuss with the patient and/or their family members or carers (as appropriate) other options such as:

  • self‑care with over‑the‑counter preparations
  • back‑up (delayed) prescribing
  • other non‑pharmacological interventions, for example, draining the site of infection.

Specific recommendations are made about not issuing an immediate prescription for an antimicrobial to a patient who is likely to have a self‑limiting condition. Also not issuing repeat prescriptions for antimicrobials unless needed for a particular clinical condition or indication. Avoid issuing repeat prescriptions for longer than 6 months without review and ensure adequate monitoring for individual patients to reduce adverse drug reactions and to check whether continuing an antimicrobial is really needed.

Interestingly, an BMJ news article states that previous NICE guidelines that encouraged reduced antibiotic prescribing actually resulted in an increase. To help prevent this happening again a public health guideline aimed at reducing the public’s desire for antibiotics will be published next year. It’s hoped that changing public knowledge, attitudes, and behaviours in relation to the use of antimicrobials will assist prescribers in prescribing antimicrobials appropriately.

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