Smart Antibiotic Usage- June 2013

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 Doctors core skills programme developed in the Trust.

Local (HEFT) Policies

Antibiotic anti-ineffective duration policy

Review date: July 2013

Antibiotic Guidelines

Review date: July 2013

Antibiotic treatment for severe  sepsis of unknown origin

Review date: July 2013

Antibiotic treatment for neutropenic sepsis

Review date: July 2013

Neutropenic Sepsis Pathway

Review date: August 2013


NICE guidelines and pathways

Neutropenic sepsis - NICE Pathways

Created September 2012 - updated May 2013

Self-limiting respiratory tract infections – antibiotic prescribing overview

Created September 2012 - updated February 2013


Map of Medicine

Browse the “Medicines” Care Map

Use HEFT Athens ID to login to Map of Medicine.

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


Other National Guidelines (e.g. SIGN) & Non-UK Guidelines (includes Professional Bodies/Associations within the European Union)

Guideline on setting specifications for related impurities in antibiotics

Date of coming into effect: June 2013

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.

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

Silva BNG, Andriolo RB, Atallah AN & Salomao R

De-escalation of antimicrobial treatment for adults with sepsi, severe sepsis or septic shock

March 2013

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.

Teicoplanin versus vancomycin for proven or suspected infection

Cochrane Database of Systematic Reviews 2010

Vancomycin and teicoplanin are commonly used to treat gram-positive infections, particularly those caused by methicillin-resistantStaphylococcus aureus (MRSA). There is uncertainty regarding the effects of teicoplanin compared to vancomycin on kidney function with some previous studies suggesting teicoplanin is less nephrotoxic than vancomycin. Teicoplanin and vancomycin are both effective in treating those with proven or suspected infection; however the incidence of adverse effects including nephrotoxicity was lower with teicoplanin.

Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care

Cochrane Database of Systematic Reviews 2009

Pneumonia is an important cause of mortality in intensive care units (ICUs). The incidence of pneumonia in ICU patients ranges between 7% and 40%, and the crude mortality from ventilator-associated pneumonia may exceed 50%. Although not all deaths in patients with this form of pneumonia are directly attributable to pneumonia, it has been shown to contribute to mortality in ICUs independently of other factors that are also strongly associated with such deaths.

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

Evidence: Safer Patient Initiative Phase 2.

The Health Foundation. February 2011.

A controlled evaluation of the second phase of a complex patient safety intervention implemented in English hospitals.

Evidence: Safer Patient Initiative Phase 1.

The Health Foundation. February 2011.

The Safer Patients Initiative (SPI) was a complex, large-scale intervention and the first major improvement programme addressing patient safety in the UK.

The initiative was designed to test ways of improving patient safety on an organisation-wide basis within hospitals across the UK.

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

National Confidential Study of Deaths Following Meticillin Resistant Staphylococcus aureus (MRSA) Infection: 2007

Health Protection  Agency. November 2007.

This qualitative research study provides an in-depth description and evaluation of patient and institutional factors leading to the deaths of a small randomly selected sample of patients who died in NHS hospitals in England who had MRSA mentioned on their death certificate (pilot phase) or who died within 30 days of an MRSA positive blood culture specimen being taken (main phase).


Further information:

The following sources have been searched for evidence published in the previous 12 months: HEFT Policies, NHS Evidence, NICE, SIGN, NPSA, and the Cochrane Library. Please contact [email protected] for any further information.

For more information on how to make the most use of the HEFT Library Services, visit Visit NHS Evidence to access your guidelines, Cochrane systematic reviews, journals and databases.