Safe Prescribing- January 2013

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Smart Antibiotic Usage


Listed below is the high level evidence on Smart Antibiotic Usage produced by NICE, SIGN and NHS based organisations. Also included are the European Society guidelines where available. This list is produced and maintained by HEFT Library Services to support VITAL 4 Medics core skills programme developed in the Trust.


Heart of England Sepsis Tool

Screening Tool to be used on HeFT wards - Adult MEWS Chart. June 2012


Map of Medicine


Browse the “Medicines” Care Map

A range of pathways for management of infectious diseases are listed and have links to antibiotic usage. Select “medicines”, then “infectious diseases”. Examples are as follows:-


Meticillin-resistant Staphylococcus Aureus (MRSA) – Presentation of suspected or confirmed active Infection.


Neutropenic Sepsis - Suspected


Septic Arthritis Management



National Guidelines & Non-UK Guidelines (includes Professional Bodies/Associations)


Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy

F. Kate Gould et al.

Journal of Antimicrobial Chemotherapy (2012) 67, 269–289

The aim of these guidelines, which cover both native valve and prosthetic valve endocarditis, is to standardize the initial investigation and treatment of IE. An extensive review of the literature using a number of different search criteria has been carried out and cited publications used to support any changes we have made to the existing guidelines.


Antimicrobial stewardship: Start smart - then focus

Department of Health. November 2011.

The aim of this guidance is to provide an outline of evidence-based antimicrobial stewardship in the secondary healthcare setting. Following this Guidance will help organisations to demonstrate compliance with Criterion 9 of The Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance.






Antibiotics for community-acquired pneumonia

Matthew Dryden et al.

Journal of Antimicrobial Chemotherapy (2009) 64, 1123–1125

Antibiotic guidelines for community-acquired pneumonia (CAP) often recommend broad-spectrum agents for severe pneumonia. While these may be entirely appropriate in terms of their spectrum of activity and efficacy, there is a risk that such recommendations could result in over-prescribing of broad-spectrum agents with consequent ‘collateral damage’, meaning superinfection by resistant pathogens, or selection of antibiotic resistance. Narrow-spectrum agents are often as effective and

result in less collateral damage. National and local antibiotic guidance should  promote choices of agents for narrow-spectrum prescribing even for severe CAP where appropriate.


Antibiotic Prophylaxis in Surgery

SIGN Guideline No. 104, July 2008

This guideline makes recommendations on best practice in the use of peri-operative prophylactic antibiotics to prevent surgical site infections (SSI). SSI is a major cause of healthcare acquired infection. Other areas of concern such as antibiotic allergy, cost effectiveness and meticillin-resistant Staphylococcus aureus (MRSA) are considered.


Systematic Reviews – Cochrane Library


Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults

Cochrane Database of Systematic Reviews 2011

A review of strategies intended to limit duration of antibiotic therapy for hospital-acquired pneumonia in intensive care unit patients.


Antibiotic policies for short-term catheter bladder drainage in adults

Cochrane Database of Systematic Reviews 2005

Catheters may be used to drain the bladder in hospital for short periods of time (less than two weeks). This may cause a urine infection, or an increase in the number of bacteria in the urine. The review found that people who had antibiotics before or during catheter use were less likely to have an infection, and less likely to have a large number of bacteria or pus cells in the urine. However, there was no evidence about the chance of allergic reactions or other side effects from the antibiotics, nor about the chance of developing bacteria with antibiotic resistance. There was weak evidence that antibiotic prophylaxis compared to giving antibiotics when clinically indicated reduced the rate of symptomatic urinary tract infection in female patients with abdominal surgery and a urethral catheter for 24 hours.


Interventions to improve antibiotic prescribing practices for hospital inpatients

Cochrane Database of Systematic Reviews 2005

Antibiotics are used to treat infections, such as pneumonia, that are caused by bacteria. Over time however, many bacteria have become resistant to antibiotics. Antibiotic resistance is a serious problem for individual patients and health care systems; in hospitals, infections caused by antibiotic-resistant bacteria are associated with higher rates of death, illness and prolonged hospital stay. Bacteria often become resistant because antibiotics are used too often and incorrectly. Studies have shown that about half of the time, antibiotics are not prescribed properly in Hospitals. The results show that interventions to improve antibiotic prescribing to hospital inpatients are successful, and can reduce antimicrobial resistance or hospital acquired infections.

NHS Evidence


Reducing Healthcare Associated Infections in Hospitals in England

National Audit Office. June 2009

Every year over 300,000 patients in England acquire a healthcare associated infection whilst in hospital. These infections cost the NHS more than £1 billion a year. The House of Commons Public Accounts Committee has published its third report on reducing healthcare associated infection in hospitals in England. In 2000, the predecessor Committee had concluded that the NHS did not have a grip on the extent and costs of hospital acquired infection and that without robust data it was difficult to see how it could target activity and resources to best effect. In 2005, this Committee found that progress in improving infection prevention and control had been patchy and there was a distinct lack of urgency on key issues such as ward cleanliness and compliance with good hand hygiene.


Antimicrobial Resistance and Prescribing in England, Wales and Northern Ireland.

Health Protection  Agency. July 2008.

This is the fifth report from the Health Protection Agency (HPA) aimed at providing an overview of antimicrobial resistance in a range of pathogens of public health importance. While this report focuses on data collected by the HPA during 2007, trend data over a longer period of time are also presented to highlight that antimicrobial resistance is not a static problem but one that changes over time.