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UK recommendations for combating antimicrobial resistance: a review of ‘antimicrobial stewardship: systems and processes for effective antimicrobial medicine use’ (NICE guideline NG15, 2015) and related guidance
  1. Gabriella L Morley1,
  2. Ian D Wacogne2
  1. 1Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  2. 2Department of General Paediatrics, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Gabriella L Morley, Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, B4 6NH, Birmingham, UK.; gabriella.morley{at}nhs.net

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Background

Antimicrobial resistance (AMR) is a major health threat. In 2011, the UK’s chief medical officer’s annual report described AMR as an ‘apocalyptic scenario’1 in which common infections would become untreatable, and young children, arguably the most susceptible to infectious disease, would bear the burden.

The problem is caused by overuse and misuse of antibiotics resulting in the survival and spread of resistant bacteria. A recently published review on AMR (2016), outlines the enormity of the problem: ‘by 2050, 10 million lives a year… are at risk due to the rise of drug-resistant infections if we do not find proactive solutions now. Even today, 7 00 000 people die of resistant infections every year’.2

The clinician plays a major role in one of the identified solutions: antimicrobial stewardship to preserve drug effectiveness (box 1). This can be a particular challenge in paediatrics: a feverish child may have a serious bacterial infection, almost impossible—at first—to distinguish from a self-limiting viral infection. In neonates, sepsis can be particularly difficult to identity; therefore, in both cases, antibiotics are often given as a precautionary measure.

Box 1

Definitions

  • Antimicrobial stewardship: ‘an organisational or healthcare-system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness’,

  • Antimicrobial resistance: ‘loss of effectiveness of any anti-infective medicine, including anti-viral, anti-fungal, antibacterial and anti-parasitic medicines’.3

Information about current guideline

The National Institute for Health and Care Excellence (NICE) was appointed by the Department of Health and Public Health England to produce the guideline: ‘Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use’3 (box 2). This addresses the growing threat of AMR by promotion of evidence based directives for appropriate antimicrobial use.

The guideline covers information relevant to commissioning organisations and system management as well as clinicians. This review, however, will only focus on information relevant to the clinician and includes other …

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