New medicinesHealth and social care providers need help to tackle the growing threat of antimicrobial resistance, according to the National Institute for Health and Care Excellence.

NICE’s draft medicines practice guideline on antimicrobial medicines is to help health and social care commissioners, providers and prescribers to monitor the sensible use of antimicrobials to preserve their future effectiveness.

Antimicrobial medicines such as antibiotics have been the mainstay of treating infections for over 60 years. Although a new infectious disease has been discovered nearly every year during the past 30 years, few new antibiotics have been developed. As a result, 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 steadily increasing over several years.

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

“NICE’s recent guidance on diagnosing and treating pneumonia takes as its starting point the need for accurate assessment of respiratory infections like pneumonia to allow healthcare professionals to prescribe antibiotics responsibly,” he said.

“This adds to a number of initiatives to tackle the growing concerns about antimicrobial resistance and the appropriate use of antimicrobials, all within the context of overall antibiotic prescribing that has increased in primary care in England year on year.

“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.”

As well as highlighting the need for local antimicrobial stewardship programmes, the draft guideline also recommends setting up multidisciplinary antimicrobial stewardship teams working across all care settings. These teams should be able to review prescribing and resistance data frequently and feed this information back to prescribers.

They should also be able to work with prescribers to understand the reasons for high, increasing or low volumes of antimicrobial prescribing as well as provide feedback and assistance to prescribers who prescribe antimicrobials outside of local guidelines where this is not justified.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “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.”

“But it’s not just prescribers who should be questioned about their attitudes and beliefs about antibiotics. It’s often patients themselves who, because they don’t understand that their condition will clear up by itself, or that perhaps antibiotics aren’t effective in treating it, may put pressure on their doctor to prescribe an antibiotic.”