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28.11.18

Turning the tide on antimicrobial resistance

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, provides her view of the institute’s newly published impact report on antimicrobial resistance.

Around 700,000 deaths occur every year worldwide due to infections that we cannot treat due to antimicrobial resistance (AMR). This number is set to increase to 10 million by 2050. As World Antibiotic Awareness week recently highlighted, there is much more that we can all do to tackle AMR and significantly decrease the number of deaths.

Challenging the rise of AMR has been a priority for NICE over the years. Since publishing our first piece of guidance on antibiotic use in 2008, we have produced a range of evidence-based guidance, standards, and resources on AMR. These aim to change prescribing practice, slow the emergence of AMR, and ensure that antimicrobials remain an effective treatment for infection.

What progress are we making to achieve these important goals?

This is something that our new AMR impact report seeks to address. It highlights how NICE guidance is being used in practice and the progress we as a health and care system are making in the fight against antimicrobial resistance.

One area that the report explores is antibiotic prescribing in primary care and what is being done to reduce this. We found that, since the publication of the UK Five Year Antimicrobial Resistance Strategy, a number of incentives, alongside NICE guidance, have been put in place to encourage appropriate prescribing in primary care.

For example, NHS England’s Quality Premium, which rewards clinical commissioning groups (CCGs) for improvements in the quality of the services they commission, introduced a focus on appropriate antibiotic prescribing in 2015. This requires CCGs to reduce the number of antibiotics prescribed and the percentage of those prescriptions which are for broad spectrum antibiotics.

Data suggests that this is having a positive effect. By the start of 2018, over 80% of CCGs had reduced their antibiotic prescribing levels to below the 2013 England average.

This is good news and demonstrates that primary care professionals are making significant changes to how they prescribe antibiotics. However, our report also points out that there remains wide variation in the prescribing of antibiotics in different areas of England, suggesting that there is still room for improvement in many areas.

Another important focus of our report is antimicrobial stewardship (AMS) in secondary care. Unlike in primary care, the overall use of antibiotics in hospitals has been rising in recent years. In light of this, there have been significant developments made across the health and care system. For example, in our NICE AMS guideline (2015), we recommend that organisations establishing AMS teams should ensure that core members include an antimicrobial pharmacist and a medical microbiologist.

A survey carried out by Public Health England as part of the 2017 ESPAUR report demonstrated that all AMS committees had implemented this recommendation. The survey also showed that the NICE AMS guideline was discussed by 93% of trust AMS committees and 83% had completed its baseline assessment tool.

This shows us that AMS teams across the country are working hard to change the culture of antimicrobial use in our hospitals to preserve their future effectiveness.

Overall, our report demonstrates that in the past five years there has been promising movement across both primary and secondary care to tackle AMR head-on. But the scale of the problem means there is a huge amount of work still to be done.

So we must continue to work together – patients and professionals – to transform a culture of antimicrobial waste, overuse and misuse. We must also support the development of new antimicrobial medicines and encourage companies to develop them. And only then will the tide really begin to turn on this global problem.

To access the full AMR impact report, please go to the NICE website.

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