The National Institute for Health and Care Excellence has caused a stir with its proposed measures to tackle antibiotic resistance, which include setting up “antimicrobial stewardship teams” to keep a closer watch on local prescribing.

The agency has issued draft guidelines to help “health and social care commissioners, providers and prescribers promote and monitor the sensible use of antimicrobials to preserve their future effectiveness”.

NICE cited national antibiotic charts, published by NHS Prescription Services, which show that overall antibiotic prescribing in the community in England has been steadily increasing over several years. Mark Baker, director of its Centre for Clinical Practice, said that 41.6 million antibacterial prescriptions were issued in 2013-14 at a cost to the NHS of £192 million.

Furthermore, “despite considerable guidance that prescribing rates of antibiotics should be reduced”, he noted that nine out of  ten GPs feel pressured to prescribe them; 97% of patients who ask for antibiotics get them.

'Open and transparent culture'

Prof Baker added that the draft guidance “recognises that we need to encourage an open and transparent culture that allows health professionals to question antimicrobial prescribing practices of colleagues when these are not in line with local and national guidelines and no reason is documented”.
The draft says that stewardship teams “should also be able to work with prescribers to understand the reasons for very high, increasing or very low volumes of antimicrobial prescribing as well as provide feedback and assistance to prescribers who prescribe antimicrobials outside of local guidelines where this is not justified”.

Prof Baker added that the guideline also says prescribers take time to discuss with patients “the benefits and harms of immediate antimicrobial prescribing” and alternatives such as “watchful waiting and/or delayed prescribing”. It also recommends that patients are given advice about who they should contact if they have concerns about infection after discharge from hospital.

Richard Anderson, chief executive at UK wound care company Crawford Healthcare, said “NICE is right to express its concern over the rising use of antibiotic treatment” because oversubscribing is “continuing to weaken their impact as a first point of care”.

He added that “as serious secondary infections grow in response to antibiotic resistance, topical treatment is becoming more and more appropriate”.