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Antimicrobial resistance strategy calls for better prescribing

The Government’s five-year antimicrobial resistance strategy sets out plans to improve prescribing practice, make better use of rapid diagnostics and improve professional education in the NHS to ensure clinicians understand the need for more sustainable use of antibiotics.

The strategy also calls for infection prevention practices to be further strengthened.

In March, chief medical officer Professor Dame Sally Davies warned that increasing bacterial resistance posed a “catastrophic threat” to the world.

On prescribing, the new strategy says: “Indiscriminate or inappropriate use of antibiotics is a key driver in the spread of antibiotic resistance. There is already an extensive range of guidance, education, tools and industry-sponsored initiatives to promote the responsible use of antibiotics in patients and animals, but most prescribing is carried out in the absence of adequate information about the nature of the infection or before the results of diagnostic testing are available.

Educating both clinicians and the public is a key element of the strategy, which notes: “Clinicians involved in prescribing need to remain up to date with emerging evidence on resistance and appropriate antibiotic usage. One way to help clinicians achieve this is by ensuring that continuing professional development programmes include the competences required for effective antibiotic stewardship.

“Patients frequently believe, incorrectly, that antibiotics will help them recover from all respiratory tract infections faster. In addition, studies have shown that up to 25% of patients in England do not finish their course of antibiotics or keep them for later use, all practices that encourage AMR. Patient consultations can be difficult when patients expect antibiotics for self-limiting infections. More needs to be done to educate patients and the public more generally about appropriate antibiotic use.”

The strategy aims to improve prevention and infection management in both people and animals, through better hygiene in medical and community settings, alongside better farming practices.

Better data on resistance could improve the effectiveness of tracking bacteria.

A new NIHR Health Protection Research Unit will be set up to focus on AMR and healthcare associated infections, while work will continue to develop new forms of antibiotics.

Public health minister Anna Soubry said: “The Chief Medical Officer’s stark warning showed that bacteria are adapting fast and if we don’t take action, we could face serious problems in years to come.

“That’s why this strong, cross government strategy sets out real actions to stay one step ahead and fight antimicrobial resistance both nationally and internationally.

“But this is really a problem that society has to take on together, through better education, treatment and monitoring of bacteria. Whether you’re a patient, a doctor or a vet, we all have a role to play in prescribing and using antibiotics responsibly.”

Professor Dame Sally Davies welcomed the strategy and said: “Antimicrobial resistance is a global problem and we all need to take responsibility.”

The following is an extract from the strategy, setting out the CMO’s recommendations:

1. Action is needed at the international, national and local level: antimicrobial resistance should be an issue that has the same level of political interest as methicillin resistant Staphylococcus aureus (MRSA) and C. difficile in England. It should be placed on the ‘national risk register’ (specifically, the National Security Risk Assessment) and the government should campaign for it to be given higher priority internationally, including collaborations to ensure the development of new antimicrobials and vaccines such as Private Public Partnerships.

2. The national approach to tackling antimicrobial resistance should be managed jointly between DH and Defra to ensure that a comprehensive integrated programme is developed. The UK 2013 to 2018 cross government antimicrobial resistance strategy and action plan is welcome. It provides a base for future working but this needs to be built upon.

3. Rapid diagnostics enabling appropriate treatment and surveillance will be key to addressing the issues raised by imported infections. Identification of imported infections and carriage of organisms with antimicrobial resistance is critical. Once identified, effective infection control mechanisms exist for most infections. This should be a specific focus within the Public Health England surveillance strategy.

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