Tag: Antibiotics

Seek advice from a qualified healthcare professional before taking antibiotics

By Dr Timothy Rawson, Clinical Research Fellow, Esmita CharaniSenior Lead Pharmacist and Dr Enrique Castro Sanchez, Academic Research Nurse all from the Faculty of Medicine, Department of Medicine

Antibiotics are a powerful resource that allows us to safely perform surgery, treat cancer with chemotherapy, and recover from infections that over 100 years ago would have killed even the fittest among us.

We are seeing however, a dramatic increase in infections with bacteria resistant to the killing effects of antibiotics (termed drug-resistant infections). These are antibiotics that until recently used to be effective. These resistant bacteria make many infections more and more difficult to treat – in some cases causing patients to die because we no longer have antibiotics that are able to manage the infection.

A major driver of drug-resistant infections is the overuse and misuse of antibiotics. We outline some of the key reasons for this below.

Firstly, some health problems cannot be treated with antibiotics, and it is important to know which ones they are. In some cases, health problems that can be treated with antibiotics need consideration about the right antibiotic for each person. For example, it would be important to consider whether people are taking other medications, whether they have got any other health problems, and even their preferences.

Talking to a health professional helps build relations that are proven to be essential for the experience of people related to antibiotic use. We now know that whilst patients are eager to receive more information about their use of antibiotics, previous experiences about having antibiotics prescribed (or not) gradually imprints expectations about antibiotics. Therefore, having the opportunity to discuss antibiotics with a healthcare professional may also have an impact on future attitudes and expectations when you feel unwell.

As all medications, antibiotics can have negative side effects that may be important to your current and future health. Often without previous discussion with a healthcare professional, it may be difficult to forewarn patients about such side effects and what to do should they appear. The ability to be able to warn someone about certain antibiotics may encourage them to keep taking them if they experience the side effect, or even ensure that they seek help immediately in rarer cases.

The conversation between healthcare professionals and patients about antibiotics are shaped by many factors that are not just related to health. These can reflect cultural beliefs and traditions, expectations, power relations between professionals and patients, the skills that the patient may have to deal with health problems, as well as social circumstances. Patients may feel compelled to access, or request antibiotics as a quick solution to a health problem that may prevent them from going to work. However, antibiotics are not always the solution and in some cases may worsen the problem due to the side effects that patients experience.

Conversations with healthcare professionals allows people to receive useful information about self-care measures that can resolve symptoms and prevent further health problems. For example, painkillers, fluids, and rest may be all that is required to deal with a cold. Being up to date on influenza vaccination, and washing hands thoroughly and correctly could ensure that the risk of catching infections is much reduced.

Studies show that whilst citizens are in agreement with healthcare professionals that the main reason causing drug-resistant infections is antibiotic use, they are not aware of the range of factors driving antibiotic use. Therefore, facilitating opportunities for these conversations to take place would be beneficial to raise awareness and optimise antibiotic use.

Encouraging citizens to engage with professionals in conversations about antibiotics would require that professionals embrace communications approaches and skills that result in meaningful and actionable information for patients and ultimately shared-decision making. Considering that the information related to infections is difficult to understand and process in the time allowed for typical consultations in primary care and due to the limited familiarity of the average citizen with scientific jargon/language, such conversations may be difficult. However, through the use of information aids  and a greater understanding of what information patients desire, we may be able to facilitate meaningful engagement with decision-making even in the most time pressured of situations.

In summary, we all have a role in using antibiotics more responsibly, through better communication approaches that encourage shared-decision making between citizens and healthcare professionals.

Using the evidence-based approach to better antibiotic stewardship

By Chris Bird, MSc Health Policy student at Imperial College and Project Manager in the System Engagement Programme at NICE

This week marks World Antibiotic Awareness Week, the theme of which is to seek advice from a qualified healthcare professional before taking antibiotics.

Antibiotic resistance (AMR) is one of the biggest threats to global health, food security and development in our world today. Antibiotic resistance leads to high medical costs, prolonged hospital stays and increased mortality.

It’s a subject brought home to me as I was lucky enough to study my MSc in the very same historic buildings at St Mary’s Hospital where Alexander Fleming first discovered the miracle of penicillin. This was the first ever antibiotic with capabilities to revolutionise world healthcare by eradicating the scourge of gangrene and tuberculosis. Skip forward to today and the availability of effective antimicrobials are estimated to add approximately 20 years to human life expectancy.

AMR describes the process by which microbes become resistant to the common range of antibiotics used in human and animal health to combat infection. Excessive use and inappropriate prescribing of antibiotics, coupled with a lack of research and development into the identification of new antibiotics have combined to produce a significant threat to world population health.

The UK’s Chief Medical Officer (CMO), Dame Sally Davies has referred to AMR as a ‘ticking timebomb[i] with potential consequences for the nation’s health, so serious that the issue has been logged on the UK’s cross-government national risk register.

 

Risks and costs 

Where antibiotics can be bought for human or animal use without a prescription, the emergence and spread of resistance is made worse. Similarly, in countries without standard treatment guidelines, antibiotics are often over-prescribed by health workers and veterinarians and over used by the public.

As the late great U.S President John F. Kennedy once said, “There are risks and costs to action. But they are far less than the long term risks of comfortable inaction”.

Kennedy’s words are as relevant and compelling today as they ever were. If we as a society opt for comfortable inaction and if AMR is left unchecked, a time in the not too distant future could come where the risks of infection are too high to perform treatment in common fields of medicine such as cancer, orthopaedics and birth by caesarean section. For urinary tract infections, antibiotic resistance is now already commonplace[ii].  Our health systems and all the progress made in advancing patient outcomes could come to a grinding halt.

 

Taking steps to address the challenge

In the UK, the National Institute for Health and Care Excellence (NICE) is the independent body responsible for producing the nation’s guidance and advice to improve health and social care. Recent guidance addresses the specific threat of AMR and the changes in practice required to tackle it. Encouraging system-level change at this scale has its challenges. And yet incremental change by the thousands of individual healthcare professionals, taken collectively – with the support of the general public, has the potential to make significant and meaningful progress in this global fight.

One of NICE’s guidelines targeted at the general population, covers awareness-raising on how to correctly use antimicrobial medicines (including antibiotics) and the dangers associated with their overuse and misuse. It aims to change people’s behaviour to reduce antimicrobial resistance and the spread of resistant microbes.

Another NICE guideline is targeted at prescribers. It covers the effective use of antimicrobials (including antibiotics) in children, young people and adults. It aims to change prescribing practice to help slow the emergence of AMR and ensure that antimicrobials remain an effective treatment for infection.

While antimicrobial stewardship work has always been part of medicines optimisation, the NICE guideline is intended as a tool to enable change and focus on these issues. We have positive examples in our Uptake and Impact report of where frontline healthcare professionals have done so with encouraging results.

In Northamptonshire, GPs received a large number of broad-spectrum antibiotic co-amoxiclav prescription requests from podiatrists. This was addressed by training podiatrists on antimicrobial stewardship, and including antibiotics in their toolkit as independent prescribers. This encouraged ownership of the prescribing and resulted in a reduction in the prescribing of co-amoxiclav, cephalosporins and quinolones as a percentage of antibiotics from 11% to 8% (Nene and Corby CCGs, March to October 2016), which the GPs largely ascribed to the medicines optimisation work with podiatrists.

In Southampton, providing one to one support had the biggest impact in changing prescribing behaviour. Specific patient examples were discussed with individual prescribers. Data for 12 months up to July 2016 showed that cephalosporins, quinolones and co-amoxiclav prescribed as a percentage of all antibiotic items reduced from 13% to 11%.

 

A global call to action

AMR is a worldwide problem and we know that evidence-based NICE guidance has the ability to influence innovation and change in practice, not just at home but by clinicians, prescribers and the general population in countries overseas. Take the opportunity given by World Antibiotic Awareness Week to consider NICE’s guidance. Think how you might use this to change and improve your own practice, and strive to be a better antibiotic steward for this and future generations.

If you are a healthcare professional or prescriber using NICE guidance to deliver good practice in antibiotic stewardship, NICE would like to hear about. Tell us about the work you’re doing by completing the submission form here. 

[i] The Independent. Resistance to antibiotics is ‘ticking time bomb’ – stark warning from Chief Medical Officer Dame Sally Davies. 2013. Available at: http://www.independent.co.uk/news/science/resistance-to-antibiotics-is-ticking-time-bomb-stark-warning-from-chief-medical-officer-dame-sally-8528469.html

[ii] NICE. Antibiotic resistance is now “common” in urinary tract infections. 2017. Available at: https://www.nice.org.uk/news/article/antibiotic-resistance-is-now-common-in-urinary-tract-infections?utm_medium=social&utm_source=twitter&utm_campaign=espaurnews

Antibiotic resistance is a true global health issue

By guest blogger, Paul Kiet Tang, Senior Assistant Editor at The Lancet*

AntibioticsSince its discovery and widespread use, antibiotics have been marvelled as a panacea that has revolutionised modern day medicine. Routine surgical procedures, childbirth, and open wounds are no longer associated with high risks of mortality from infections. However, the overuse and misuse of these drugs have led to increased concerns of antibiotic resistance worldwide, with up to 700,000 people dying globally from antibiotic-resistant infections. In the final 2016 report of The Review on Antimicrobial Resistance from the UK Government and the Wellcome Trust, this incidence was projected to increase to 10 million people per year by 2050, costing the global economy up to 100 trillion US dollars and pushing about 28.3 million people into extreme poverty. These statistics must not be ignored if health-care professionals, stakeholders, and governments worldwide are to avert this catastrophic outcome.

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Practitioner and patient-targeted interventions to address excessive antibiotic use

By Dr Olga KostopoulouReader in Medical Decision Making and Professor Brendan DelaneyChair in Medical Informatics and Decision Making at Imperial College London 

Antibiotics Combatting antimicrobial resistance (AMR) is high on policy agendas internationally. One of the key means advocated is judicious antibiotic prescribing. Over 80% of all NHS antibiotic prescriptions are issued in primary care, where despite numerous campaigns, mandates and financial incentives, rates have fallen only slightly in the past year. Acute respiratory infections and associated complications, such as pneumonia, are the commonest justification for primary care antibiotic use, despite strong evidence of small to modest symptomatic benefits. GPs admit to prescribing because of diagnostic uncertainty, defensive practice, and real or perceived patient demand. Patients request antibiotics because of their perceived effectiveness, poor understanding of AMR, and lack of awareness of their susceptibility to complications of infections caused by their own resistant bacteria.

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