The UK 5-year AMR Strategy - a brief overview - Amazon S3 · The UK 5-year AMR Strategy - a brief...
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The UK 5-year AMR Strategy - a brief overview -
Dr Berit Muller-Pebody National Infection Service Public Health England
Chief Medical Officer - Annual Report 2013
Antimicrobial resistance poses ‘catastrophic threat’
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The UK 5 Year Strategy
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• Improve the knowledge
and understanding of AMR • Conserve and steward the
effectiveness of existing treatments
• Stimulate the development
of new antibiotics, diagnostics and novel therapies
Implementing the UK Strategy - The 7 key areas -
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PHE Human health
Department of Health (DH) – High Level Steering Group
Defra Animal health DH
1. Improving infection prevention and control practices
2. Better access to and use of surveillance data
3. Optimising prescribing practice 4. Improving professional education,
training and public engagement
5. Improving the evidence base through research
6. Developing new drugs, treatments and diagnostics
7. Strengthening international collaboration
Improving infection prevention & control
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• Development of a National Strategy • CPE Acute & Non-acute Toolkits • Work with NICE to update guidelines
• Quality Statement on prevention of HCAIs
Better access and use of surveillance data
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• Overall, AMR continues to increase, though with a slower rate of increase from 2013 to 2014 than in previous years
• Total antibiotic prescribing, measured
using defined daily doses, continues to increase in all NHS areas, except Dental Practice
• The majority of total prescribing occurs
in primary care but secondary care prescribes more broad-spectrum antibiotics
NICE Antimicrobial Stewardship Guidelines
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Published in August 2015 Provides good practice recommendations on systems and processes for the effective use of antimicrobials. Recommends the use of two PHE/DH toolkits - TARGET and Start Smart – Then Focus Toolkits.
Quality and Innovation (CQUIN) & Quality Premiums
Improved antibiotic prescribing in primary and secondary care through payments to Hospital Trusts and Clinical Commissioning Groups (CCGs)
A reduction in the number of antibiotics prescribed in primary care
B reduction in the proportion of broad spectrum antibiotics prescribed in primary care
C secondary care providers validating their total antibiotic prescription data
D secondary care providers reviewing antibiotic prescribing within 72 hours of the beginning of treatment (NEW)
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Behavioural Insights
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Randomised Control Trial -reducing antibiotic prescribing through behaviour 1581 GP practices given marketing materials, CMO letter & TARGET leaflet or a combination of these plus a control group 73’406 fewer items dispensed, estimated saving of £92’356 Cheap, effective and scalable
Engaging the Public
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e-Bug is a free educational resource for classroom and home use and makes learning about micro-organisms, the spread, prevention and treatment of infection fun and accessible for all students.
Public, professionals and organizations undertake a pledge to improve their antibiotic use.
The Years Ahead
• Tackling AMR requires collaborative cross-sectoral approach, nationally and internationally
• Surveillance a foundational tool for public health action
• Shift from national level to supporting local action • Focus on international work
• Support development of national plans (WHO Global Action Plan)
• Working to secure resolution on AMR at UN General Assembly
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Acknowledgements
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HCAI & AMR Dept, National Infection Service, PHE AMR programme board, PHE
ARHAI Antimicrobial Stewardship subgroup NHS Business Services Authority
Health and Social Care Information Centre IMS Health
NHS microbiology laboratories PHE regional information managers
PHE field epidemiology services Antimicrobial pharmacists across English NHS Trusts
East of England pharmacy network All members of ESPAUR oversight group
Antimicrobial Resistance
Bacteria Antibiotic Resistance (non-susceptibility) Metric
Proportion Resistant in
2014 (%)
2014 compared to 2010*
Escherichia coli
ciprofloxacin 18.7 ↔ cefotaxime and/or ceftazidime
11.1 ↑
gentamicin 9.6 ↔
imipenem and/or meropenem 0.1 ↔
co-amoxiclav 42.0 ↑ piperacillin/tazobactam 11.0 ↑
Klebsiella pneumoniae
ciprofloxacin 10.9 ↔
cefotaxime and/or ceftazidime
12.1 ↑
gentamicin
7.5 ↔
imipenem and/or meropenem 1.5 ↑ piperacillin/tazobactam 16.9 ↑
Pseudomonas spp. ceftazidime 7.4 ↔
imipenem and/or meropenem 11.5 ↔
Streptococcus pneumoniae penicillin 4.2 ↔
Enterococcus spp. vancomycin 14.2 ↑
Staphylococcus aureus methicillin 10.0 ↓
Acinetobacter spp colistin 3.5 ↔
Neisseria gonorrhoeae ceftriaxone 0.0 ↔
azithromycin 1.0 ↔ Mycobacterium tuberculosis
isoniazid 5.5 ↔
rifampicin and isoniazid 1.6 ↔
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Antimicrobial Prescribing
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General Practice Compared to 2010
NHS Trusts
Compared to 2010
Broad Spectrum Antibiotics
Penicillins & enzyme inhibitor 0.9 ↑ 0.9 ↑
Cephalosporins 0.26 ↔ 0.22 ↑
Carbapenems 0.001 ↔ 0.08 ↑
Quinolones 0.3 ↓ 0.2 ↔
Narrow Spectrum Antibiotics
Penicillins (without enzyme inhibitors) 6.2 ↑ 1.2 ↔
Tetracycline 4.5 ↑ 0.33 ↓
Macrolides 2.7 ↑ 0.5 ↑
Sulfonamides and Trimethoprim 1.2 ↔ 0.4 ↑
Proportion of Broad spectrum antibiotics/ total antibiotics 8.5% ↓ 33.3% ↑
Total Antibiotic use expressed as DDD per 1000 inhabitants per day 17.1 ↑ 4.2 ↑
Total Antibiotic Prescriptions expressed as items per STARPU^ 1.233 ↔ NA