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Tackling the threat from antibiotic misuse

DATE: 24.06.2011

 

The Health Protection Surveillance Centre (“HPSC”)[1] recently published National Guidelines to enhance careful and appropriate antibiotic use[2].

The Guidelines detail a national standard providing for a system of monitoring and governance, known as Antimicrobial Stewardship [3] (“AMS”), to ensure the prevention and control of healthcare associated infections. Healthcare Institutions will be required to implement AMS programmes in order to comply with this standard.

Brief Summary of the Recommendations

  1. All acute hospitals should develop an AMS programme, led by a medical Microbiologist or an Infectious Diseases Consultant, to be annually assessed.
  2. National treatment guidelines should be developed for treating common infections in hospital.
  3. All hospitals should have an ongoing programme of education, encouraging principles of prudent prescribing.
  4. All acute hospitals should have 24 hour access to an accredited microbiology laboratory or microbiological and infectious disease expertise. 
  5. All acute hospitals should have at least one Pharmacist with dedicated responsibility for AMS. Pharmacists should have access to a structured training programme.
  6. All hospitals should have appropriate administrative and information technology support for AMS.
  7. Hospital managers should include rational antibiotic use as a strategic goal for their hospital.
  8. All acute hospitals should have a mutli-disciplinary Drugs and Therapeutics Committee. 

The Recommendations encourage clinical review of patients receiving antibiotics by an AMS team and regular surveillance of antibiotic use, with direct prescriber feedback. They also recommend restricted availability of specific antibiotics within hospitals.

Prescribers are recommended to follow the principles of prudent prescribing[4] and should warn patients of any associated risks or adverse effects associated with antibiotics.

It has been claimed recently in the national press that at least 50% of antibiotic use in hospitals is inappropriate[5]. Adherence to the above Recommendations should assist in combating the over-use of antibiotics, a key factor to prevent or reduce antibiotic resistance. It is obviously critical that before any recommendations are adopted an assessment is undertaken to establish whether hospitals concerned have the budgets and resources to implement the recommendations. Adoption of the recommendations without the resources to comply will only increase the risk of criticism and the potential for more litigation where hospital acquired infection is concerned.

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[1] The Health Protection Surveillance Centre (HPSC) is Ireland’s specialist agency for the surveillance of communicable diseases. It forms part of the HSE

[2] Guidelines for Antimicrobial Stewardship in Hospitals in Ireland

[3] Antimicrobial stewardship is a key component of a multifaceted approach to preventing emergence of antimicrobial resistance. Good antimicrobial stewardship involves selecting an appropriate drug and optimising its dose and duration to cure an infection while minimising toxicity and conditions for selection of resistant bacterial strains.

[4] Appendix 2 of the Guidelines for Antimicrobial Stewardship in Hospitals in Ireland

[5] Eithne Donnellan, Health Correspondent, Irish Times, 2 February 2010

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