Volume 4 No 45; 12 November 2010
Responsible prescribing of antibiotics in hospitals and primary care is a key theme of the third European Antibiotic Awareness Day 2010 (EAAD 2010) on 18 November .
The annual campaign, co-ordinated by the European Centre for Disease Prevention and Control (ECDC), aims to promote prudent antibiotic use and raise awareness among the public, and among healthcare professionals, of the threat to public health associated with antibiotic resistance.
Three sets of materials for use in national campaigns have been made available on the ECDC/EAAD website  - for members of the public; for hospital prescribers; and for primary care prescribers - and have been distributed via the relevant professional bodies in the UK. These include factsheets, key messages, checklists and toolkits designed for use in the different settings.
Hospital prescribers (ie doctors and nurses), as well as hospital managements, hospital drugs and therapeutics committees and hospital pharmacists, were selected as the most important target groups for the 2010 campaign following an opinion survey and concensus-builing exercise carried out by researchers at the University of Galway . The principal messages of the campaign are presented in a hospital managers factsheet, ie: that antibiotic resistance is an increasingly serious public health problem in Europe; that misuse of antiobiotics is one of the factors driving antibiotic resistance; that prudent use of antibiotics can reduce emergence and selection of antibiotic-resistant bacteria; and that multi-faceted strategies can result in prudent anibotic use.
Under the last heading, the factsheet puts forward six measures to promote prudent use of antibiotics that are collectively often referred to as antibiotic stewardship, ie : i) continuous education of prescribers and specialists; ii) evidence-based hospital antibiotic guidelines and policies; iii) monitoring of hospital antiobiotic resistance and antibiotic use data to guide empiric antibiotic therapy in severely ill patients; iv) the correct timing of administration, and optimal duration, of antibiotic prohylaxis for surgery; v) for some indications, using shorter rather than longer duration of treatment; and vi) taking microbiological samples before initiating empiric antibiotic theapy, monitoring culture results and streamlining antibiotic treatment based on the culture results .
In the UK, a number of related activities have been initiated under the auspices of the Department of Health (DH), the Health Protection Agency, the Royal College of General Practitioners (RCGP) and the British Society for Antimicrobial Chemotherapy (BSAC), to coincide with EAAD 2010. The RCGP will shortly launch an on-line self-tutoring module on the theme of antibiotic prescribing for respiratory tract infections, which was developed in collaboration with the HPA . Other EAAD-related UK activites include: a study day focusing on the role of nurses in antibiotic stewardship, being organised (on the 18 November) by Imperial College, London ; and related materials made available on the DH and NHS Choices websites.
In the current issue of the BSAC Journal of Antimicrobial Chemotherapy, two leading articles address the general theme of antibiotic stewardship  and the specific issue of optimisation of antibiotic prescribing in primary care settings . The latter paper refers to the recently-updated, four-page HPA Management of Infection Guide for Primary Care  - designed to be used by primary care clinicians during patient consultations - that provides evidence-based advice on antibiotic choices, course length and dose for all common infections encountered in primary care.
The global nature of antimicrobial resistance
The global nature of the problem of multi-drug-resistant bacteria with potential to affect hospital environments in the UK has been underlined by two recent national resistance alerts issued by the HPA: the first was concerned generally with carbapenem resistance in enterobacteriaceae , the second about the particular problem of multi-resistant bacteria found to have been imported from India and Pakistan [10,11].
The HPA has also drawn attention to increasing antimicrobial resistance in particular treatment areas. Emerging and continuing resistance to a number of antimicrobial agents in gonococci (the cause of gonorrrhoea) in the UK (resistant to ciprofloxacin, penicillin, tetracycline and azithromycin), for example, is being monitored by the HPA. Recently gonococcal isolates demonstrating decreased susceptibility to third generation cephalosporins, particularly prevalent in Asia, Australia, the USA and some European countries, have also been reported .
The HPA continues to actively monitor the susceptibility of common species of bacteria that cause bacteraemia, the results being published on a monthly basis in HPR .
1. European Antibiotic Awareness Day 2010 website, http://antibiotic.ecdc.europa.eu.
2. Concensus building: towards the EAAD toolkit for hospital prescribers (report by the University of Galway).
3. EAAD factsheet for hospital managers: Antibiotic Resistance.
4. Managing Acute Respiratory Tract Infections. Online course to be made available through the RCGP website: www.elearning.rcgp.org.uk.
5. Patient Advocacy and Quality Improvement, London (Hammersmith), 18 November 2010.
6. "Antibiotic stewardship programmes - what's missing?", Charani E, Cooke J and Holmes A, J Antimicrob Chemother 2010; 65: 2275-2277.
7. "Optimizing antibiotic prescribing in primary care settings in the UK: findings of a BSAC multi-disciplinary workshop 2009", McNulty CAM and Francis NA, J Antimicrob Chemother 2010; 65: 2278-2284.
8. "Management of infection guidance for primary care (for consultation and local adaptation), updated 2010". Downloadable from the HPA website: Home > Topics > Infectious Diseases > Infections A-Z > Primary Care Guidance.
9. National Resistance Alert: carbapenemases in enterobacteriaceae. HPR 3(4), 30 January 2009.
10. Multi-resistant hospital bacteria linked to India and Pakistan. HPR 3(26), 3 July 2009.
11. HPA. "Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study", HPA press release, 11 August 2010.
13. Health Protection Report routine infection reports: bacteraemia, http://www.hpa.org.uk/hpr/infections/bacteraemia.htm.