NICE lays down antimicrobial medicines guideline

NICE has set out its stall in proposing measures for health and social care providers to help tackle the increasing threat of antimicrobial resistance.

The UK health watchdog’s ultimate aim through the plans is to ensure that antibiotics continue to be successful in treating infections, as resistance is seen as such a serious threat to modern healthcare.

“The more we use antibiotics, the less effective they become as diseases evolve and become resistant to existing antimicrobial medicines” says Professor Alastair Hay, Professor of Primary Care and chair of the committee which developed the guideline.

“Resistance to all antimicrobials is increasing and, combined with a lack of new antimicrobial medicines, there is a heightened risk in the future that we may not be able to treat infections effectively.”

Through its ‘draft medicines practice guideline on antimicrobial stewardship’, NICE intends to help care commissioners, providers and prescribers promote and monitor the functional use of antimicrobials to preserve their future efficacy.

Antimicrobial medicines like antibiotics have been the mainstay for handling infections for over 60 years now, and despite a new infectious disease being discovered annually for over the past 30 years, very few novel antibiotics have been developed by comparison.

What this means is existing antibiotics are used to treat an ever-greater variety of infections and infectious diseases. NHS Prescription services annual National Antibiotic Charts show that overall antibiotic prescribing in the community in England has been progressively climbing over numerous years.

Hay adds: “This NICE guideline considers the whole area of antimicrobial prescribing. It looks at the evidence and makes recommendations for health and social care practitioners and organisations on the best ways to minimise antimicrobial resistance.”

Along with outlining a need for local antimicrobial stewardship programmes, the draft guideline also endorses setting up multidisciplinary antimicrobial stewardship teams working across all care settings.

NICE says these teams should be able to review prescribing and resistance data frequently and feed this information back to prescribers, and work with them to ascertain the reasons for very high, increasing or very low volumes of antimicrobial prescribing.

Professor Mark Baker who is the director of the Centre for Clinical Practice at NICE, says: “This draft guidance recognises that we need to encourage an open and transparent culture that allows health professionals to question antimicrobial prescribing practices of colleagues when these are not in line with local and national guidelines and no reason is documented.”

Saying it’s not just prescribers who should be questioned about their attitudes and beliefs about antibiotics, Baker also points the finger at patients as they don’t often understand their condition, and so might put pressure on their doctor to prescribe an antibiotic.

Baker adds some statistics to back this up: “Nationally, 41.6 million antibacterial prescriptions were issued in 2013-14 at a cost to the NHS of £192 million. Despite considerable guidance that prescribing rates of antibiotics should be reduced, nine out of 10 GPs feel pressured to prescribe antibiotics, and 97% of patients who ask for antibiotics are prescribed them.”

He concludes that the draft guideline therefore recommends prescribers take time to discuss with patients the likely nature of their condition, and the benefits and harms of immediate antimicrobial prescribing.

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