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The right antibiotic, at the right dose at the right time should be given to patients, to avoid the serious threat of antibiotic-resistant infections, according to new NICE guidance.

• The overuse of antibiotics leads to bugs becoming resistant to them – meaning that we may no longer be able to fight infections and disease that are currently treatable.

The National Institute for Health and Care Excellence (NICE) has published guidance to help doctors, nurses and pharmacists promote and monitor the sensible use of antimicrobials - a group of medicines that kill or stop the growth of microorganisms and include antibiotics, antivirals, antiparasitics and antifungals.

Antibiotics have been the mainstay of treating infections for over 60 years. Although a new infectious disease has been discovered nearly every year over the past 30 years, very few new antibiotics have been developed. This means existing antibiotics are used to treat an ever greater variety of infections and infectious diseases.

Overall antibiotic prescribing in England has been steadily increasing over several years. Nationally, 41.6 million antibiotic prescriptions were issued in 2013 -14 at a cost to the NHS of £192 million[1].  Despite considerable guidance that prescribing rates of antibiotics should be reduced, 9 out of 10 GPs say they feel pressured to prescribe antibiotics[2], and 97 percent of patients who ask for antibiotics are prescribed them. [3]

“The more we use antibiotics, the less effective they become. Infections can evolve and become resistant to existing medicines,” said Dr Tessa Lewis, GP and Medical Advisor to All Wales Therapeutics and Toxicology Centre and Vice Chair of the Guideline Development Group. “Resistance to antibiotics is increasing and there have been very few new antibiotics developed in recent years, so we need to make sure that, as well as searching for new antimicrobial medicines we use the ones we currently have in the most effective way.

 “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 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 very high, increasing or very low volumes of antimicrobial prescribing as well as provide feedback and assistance to those 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: “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.”

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

“Research has shown that misconceptions about antimicrobial resistance are widespread. Many people think that it is their body which becomes resistant, rather than the bacteria that cause antimicrobial-resistant infections. This often makes it feel that the issue of resistance is someone else’s problem.

“The guideline therefore recommends that prescribers take time to discuss with patients the likely nature of their condition, the benefits and harms of immediate antimicrobial prescribing, alternative options such as watchful waiting and/or delayed prescribing and why prescribing an antimicrobial may not be the best option for them – for example, if they have a self-limiting respiratory tract infection. The guideline also recommends that patients are given advice about who they should contact if they have concerns about infection after discharge from hospital.”

Dr Diane Ashiru-Oredope, Pharmacist Lead, Antimicrobial Resistance Programme at Public Health England, said yesterday: “Public Health England (PHE) welcomes this new guidance from NICE on antimicrobial stewardship for commissioners and providers.

“Antimicrobial stewardship programmes which aim to reduce inappropriate prescribing and optimise antibiotic use are a crucial part of work to combat antimicrobial resistance (AMR), and antimicrobial stewardship is an important element of the UK Five Year Antimicrobial Resistance Strategy.

“Tackling AMR is one of PHE’s national priorities and today, in partnership with NHS England and Health Education England, we have issued a patient safety alert on antimicrobial stewardship, which highlights the key tools that can help organisations fulfil many aspects of this new guidance from NICE.”

For further information, please contact the NICE press office on 0300 323 0142 /pressoffice@nice.org.uk or out of hours on 07775 583 813.

Notes for editors

References

1. HSCIC Prescriptions dispensed in the Community, England 2003-2013.
2. NESTA poll, August 2014 ‘Benefit of the doubt’ is the basis for prescribing antibiotics, finds Longitude survey.
3. General Practitioner, July 2013 Educational Talks, ‘slash GP antibiotic prescribing’

About the guidance

1. This is the first NICE guideline to deal exclusively with the issue of antimicrobial use and the growing problem of antimicrobial resistance. NICE is also developing a public health guideline that will focus on changing people’s knowledge, attitudes and behaviours in relation to the use of antimicrobials. There will also be a quality standard on antibiotic prescribingas part of a suite of new public health quality standards.
2. View the NHS England, Public Health England and Health Education England patient safety alert, and for more information please visit:http://www.england.nhs.uk/ourwork/patientsafety/psa/

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.

To find out more about what we do, visit our website:www.nice.org.uk and follow us on Twitter: @NICEComms.