Ensuring the appropriateness of an antimicrobial prescription against the national and/or local guidelines is one of the key ways in which pharmacy in GB can contribute to AMS.
The National Institute for Health and Care Excellence (NICE) offers evidence-based antimicrobial prescribing information for all care settings, with focus on bacterial infections and appropriate use of antibiotics. Each guideline topic features a visual summary of the recommendations, a guideline and an evidence review.
The Health Protection Scotland website contains a section on antimicrobial use and resistance and includes guidance, annual reports, and surveillance data, including a ‘Compendium of Healthcare Associated Infection (HAI) guidance’ signposting to relevant AMS clinical and technical guidelines.
The Scottish Antimicrobial Prescribing Group (SAPG) works with NHS boards across health and care settings in Scotland to improve antibiotic use, to optimise patient outcomes and to minimise harm to individuals and to wider society.
The Public Health Wales webpage provides resources to help you spread the message about making better use of antibiotics and help save this vital medicine from becoming obsolete.
Other organisations also produce guidelines for the management of infectious diseases
British HIV Association (BHIVA)
British Infection Association (BIA)
British Thoracic Society
Children’s HIV Association (CHIVA)
Scottish Intercollegiate Guidelines Network (SIGN)
Copies of the local antimicrobial/antibiotic formulary can be obtained from the Local Area Prescribing Committee (England), Drug and Therapeutics Committee (Scotland) or Local Health Board (Wales).
Although not directly related to pharmacy, the use of antibiotics in agriculture and livestock production contributes to antimicrobial resistance. Across the world, antibiotics are used in livestock production for disease prevention or growth promotion although it should be noted that the use of all growth promoters in farm animals was banned in the EU in 2006.
An overview of the antimicrobial resistance including statistics on the use in agriculture and livestock can be found on the Food and Agriculture Organization of the United Nations.
Numerous animal health organisations in the UK have issued guidance on the use of antibiotics in animals and these have been consolidated by the Veterinary Medicines Directorate. The VMD has also issued guidance on:
Responsible use of animals medicines on the farm
Responsible use of antibiotics under the prescribing cascade
The British Veterinary Association has published guidance on the 'Responsible use of antimicrobials in veterinary practice', and a position statement on 'The use of antibiotics in food producing animals'. Additional resources including a series of myth busters and posters for display in veterinary waiting rooms can be found on the BVA website.
The Responsible Use of Medicines in Agriculture Alliance (RUMA) has published a series of guidelines on the responsible use of antimicrobials in livestock e.g. poultry and game, pig, cattle, sheep. Other RUMA publications include:
Action plan for implementing the UK 5 year AMR strategy
Position paper on Antibiotic Resistance and Antibiotic Use in Livestock
A European One Health Action Plan against Antimicrobial Resistance (AMR) - The 'One Health' action plan includes three main objectives: making the EU a best practice region; boosting research, development and innovation on AMR; and, shaping the global agenda.
The Community Pharmacy Contribution to Tackling Antimicrobial Resistance (AMR) - The role of community pharmacy in tackling AMR and encouraging the prudent use of antimicrobials is included across all of the four key recommendations by the Pharmaceutical Group of the European Union (PGEU).
Other European organisations:
European Society of Clinical Microbiology and Infectious Disease (ESCMID)
European AIDS Clinical Society
European Society of Cardiology
Agencia Espanola de Medicamentos y Productos Sanitarios (Spain)
Agency for Healthcare Research and Quality
Alliance for the Prudent Use of Antibiotics (APUA) (United States of America)
American Hospital Association: Physician Leadership Forum
American Society for Microbiology (ASM)
Association for Professionals in Infection Control and Epidemiology (United States of America)
Australasian Society for Infectious Disease (ASID) (Australia)
Australian Commission on Safety and Quality in Health Care
Beam Alliance (France)
Belgian Antibiotic Policy Coordination Committee (BAPCOC)
Best Practice Advocacy Centre New Zealand (BPAC)
Carb-X (Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) (United States of America)
Center for Infectious Disease Research and Policy (CIDRAP) (United States of America)
Centers for Disease Control and Prevention (CDC) (United States of America)
Drive-AB (Driving reinvestment in research and development and responsible antibiotic use) (Europe)
Duke Antimicrobial Stewardship Outreach Network (United States of America)
European AIDS Clinical Society
European Centre for Disease Prevention and Control (ECDC)
European Commission
European Food Safety Authority (EFSA)
European Medicines Agency (EMA)
European Pharmaceutical Students’ Association
European Society of Cardiology
European Society of Clinical Microbiology and Infectious Disease (ESCMID)
Food and Agriculture Organization of the United Nations
Ghana National Drugs Programme (GNDP)
Global Antibiotic Resistance Partnership (GARP)
Government of Canada
Health Quality and Safety Commission New Zealand
Infection Prevention and Control Canada (IPAC)
Infectious Diseases Society of America (ISDA)
International Union Against Sexually Transmitted Infections (IUSTI)
Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC) (Russia)
Irish Institute of Pharmacy (IIOP)
Ministry of Health (Kenya)
National Centre for Antimicrobial Stewardship (NCAS) (Australia)
National Institute of Public Health and the Environment (Netherlands)
Norwegian Association for Medical Microbiology
Pediatric Infectious Diseases Society (United States of America)
Public Health Ontario (Canada)
ReAct – Action on Antibiotics (International)
Robert Koch Institut (German)
Societe Francaise de Microbiologie
Society for Healthcare Epidemiology of America
Society for Infectious Diseases Pharmacists (SIDP) (United States of America)
Students for Antimicrobial Stewardship (SASS) (Canada)
Swedish Strategic Programme Against Antibiotic Resistance (Strama) (Sweden)
Transatlantic Taskforce on Antimicrobial Resistance (TAFTAR)
World Alliance Against Antibiotic Resistance (WAAAR)
World Health Organisation (WHO)
World Organisation for Animal Health
Academy of Infection Management (AIM)
AMR Centre
Antibiotic Guardian
Antibiotic Research UK
British HIV Association (BHIVA)
British Infection Association (BIA)
British Society for Antimicrobial Chemotherapy (BSAC)
British Thoracic Society
British Veterinary Association
Centre for Pharmacy Postgraduate Education (CPPE)
Children’s HIV Association (CHIVA)
e-Learning for Healthcare: Health Education England
Future Learn (University of Dundee / BSAC)
Health E-Learning and Media (HELM) Team (University of Nottingham)
Health Protection Scotland
HealthcareCPD
Healthcare Infection Society (HIS)
Infection Prevention Society
International Pharmaceutical Federation (FIP)
International Scientific Forum on Home Hygiene
Microbiology Society
National Institute for Health and Care Excellence (NICE)
NHS Education for Scotland (NES)
North of England Commissioning Support Unit e-learning
Pharmaceutical Group of the European Union
Pharmacy Infection Network Group
Public Health Wales
Responsible Use of Medicines in Agriculture Alliance (RUMA)
Royal College of General Practitioners (RCGP)
Royal Pharmaceutical Society
Scottish Antimicrobial Prescribing Group (SAPG)
Scottish Intercollegiate Guidelines Network (SIGN)
Self Care Forum
Society for Applied Microbiology
UK Government: includes Department of Health, Public Health England, Veterinary Medicines Directorate (VMD)
UK Sepsis Trust
Wales Centre for Pharmacy Professional Education (WCPPE)
Antibiotic Action (British Society for Antimicrobial Chemotherapy)
Established by BSAC in 2011, Antibiotic Action is a global public awareness initiative to inform about infection prevention and control, drug resistance, and the appropriate use of antibiotics.
Antibiotic Guardian
A campaign where health or social care professionals, members of the public and students, educators or scientists can pledge to become an 'Antibiotic Guardian'.
Start Smart Then Focus (Public Health England)
Aimed at secondary care, this toolkit supports the development of antimicrobial stewardship.
TARGET antibiotic toolkit (Royal College of General Practitioners)
'Treat Antibiotics Responsibly, Guidance, Education and Tools' (TARGET) is a toolkit aimed at the primary care team to support antimicrobial stewardship. Included in the toolkit are a number of leaflets aimed at members of the public and which includes: 'Treating Your Infection - Respiratory Tract Infection' for community pharmacy.
ToDipOrNotToDip (Originaly led by NHS Bath and North East Somerset Clinical Commissioning Group)
An evidence-based system to manage the diagnosis and management of urinary tract infections in people living in care homes which has successfully reduced the inappropriate use of antibiotics. This pathway has now been built into the PHE/NICE guidance for management of lower UTIs.
Caring for children with coughs
Advice for parents and carers on caring for children with coughs.
Get Well Soon Without Antibiotics
Support for patients on managing cough and cold symptoms.
Self Care Forum: Fact Sheets
Range of Fact Sheets for patients on topics such as fever in children, coughs, sore throat, otitis media, common cold and sinusitis.
Treat Yourself Better
Support for patients on managing cough and cold symptoms.
When Should I Worry?
Information for parents on the management of colds, coughs, ear ache and sore throats in children.
Why Wasn't I Prescribed Antibiotics?
Advice for patients on treating common infections.
Additional Worldwide initiatives and campaigns:
Antibiotic Awareness Week (Australia)
Choosing Wisely (United States of America)
Be Antibiotics Aware (United States of America)
Infection Prevention and You (United States of America)
International Infection Prevention Week (Association for Professionals in Infection Control and Epidemiology: occurs third full week of October each year)
SAVE LIVES: Clean Your Hands (World Health Organisation - International: occurs in May each year)
Under the weather (Ireland)
Sepsis Awareness - Health Education England
Sepsis - Public Health England
Surviving Sepsis Campaign - Society of Critical Care Medicine
Think Sepsis - Health Education England
Centre for Pharmacy Postgraduate Education (CPPE)
Distance learning resources: ‘Antibacterial resistance – a global threat to public health: the role of the pharmacy team’ and ‘Antimicrobial Stewardship’.
Also available as distance learning or a workshop: ‘Antibacterials – focal point’.
e-Learning for Healthcare: Health Education England
Learning packages on a range of topics such as antimicrobial resistance and sepsis.
Future Learn (University of Dundee / BSAC)
13 online courses on a range of topics.
Health E-Learning and Media (HELM) Team (University of Nottingham)
This resource explores the NICE guidelines (2016) for assessing and managing sepsis based on the care required in a fictional case study, applicable to the management of adults and young people over the age of 12 years old with acute suspected sepsis.
HealthcareCPD
‘STAR: Stemming the Tide of Antibiotic Resistance’ is a short e-learning course on the concept of antibiotic resistance.
NHS Education for Scotland (NES)*
Facilitate local workshops on: ‘Antimicrobials in Clinical Practice’
North of England Commissioning Support Unit e-learning: antibiotic prescribing and antimicrobial stewardship in primary care
E-learning aimed at primary care physicians.
Royal Pharmaceutical Society/UK Clinical Pharmacy Association
'Building Your Confidence Around Antimicrobial Stewardship'. Learning event on 02 March 2018 aimed at pharmacists working in community or at a band 6-7 level in a hospital or GP practice setting. Further information available on the RPS website.
Health Education and Improvement Wakes
Online learning resources on: ‘Antimicrobials and infection management’ and ‘Antimicrobial stewardship and resistance’.
Royal College of General Practitioners (RCGP)
The ‘TARGET Antibiotic Toolkit’ includes a series of webinars, podcasts and e-learning resources.
e-Bug
Free educational resource for KS1 age to young adults teaching about microbes and antibiotics.
Fungi 4 Schools
Mycology teaching resources for teachers of children from KS2 to post-16.
Home Hygiene and Health (International Scientific Forum on Home Hygiene)
Series of training materials covering home hygiene and the home and peri-domestic settings.
Microbiology Online
Hosted by the Microbiology Society this website supports the teaching and learning of microbiology in the classroom across the key stages.
Improving Antimicrobial Prescribing: training video for doctors-in-training. Produced as part of a review of interventions to improve antimicrobial prescribing behaviours of doctors in training. Original article published in the Journal of Antimicrobial Chemotherapy.
Agency for Healthcare Research and Quality
AHRQ provides a Nursing Home Antimicrobial Stewardship Guide.
Center for Infectious Disease Research and Policy (CIDRAP)
CIDRAP signposts to various education and training resources worldwide.
Infectious Diseases Society of America
Online course: Healthcare Epidemiology, Infection Control and Antimicrobial Stewardship
Irish Institute of Pharmacy (IIOP)
Offer an ‘Antibiotic Stewardship Programme’.
Society of Infectious Diseases Pharmacists (SIDP)
Based in the USA, SIDP offer an ‘Antimicrobial stewardship certificate program for pharmacists’.
An overview of the UK AMR strategy and policy can be found on the Government's website as the ‘Antimicrobial Resistance Collection’. The collection includes strategic publications, clinical or technical guidance and resources for healthcare professionals, livestock professionals, research, as well as news items:
UK 5 Year Action Plan for Antimicrobial Resistance 2019 to 2024. Department of Health
English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report. Public Health England
Antimicrobial Resistance: resource handbook. Public Health England
AMR: summary of the current evidence. Department of Health
Tackling Drug-Resistant Infections Globally. UK Government and Wellcome Trust
Antimicrobial prescribing and stewardship competencies. Public Health England
Health matters: preventing infections and reducing antimicrobial resistance: Public Health England
Infectious diseases (covering over 100 infectious diseases). Public Health England
Standards for microbiology investigations: collection. Public Health England
Immunisation: Collection. Public Health England
Primary Care Guidance: Diagnosing and managing infections: collection. Public Health England
Care homes: infection prevention and control. Department of Health/Public Health England
FIP has a programme of work on AMR that aims to unite pharmacists for a global action. Find out more
Other worldwide organisations:
Australasian Society for Infectious Disease (ASID)
Australian Commission on Safety and Quality in Health Care
Best Practice Advocacy Centre New Zealand (BPAC)
Center for Infectious Disease Research and Policy (CIDRAP) (United States of America)
Centers for Disease Control and Prevention (CDC) (United States of America)
Infection Prevention and Control Canada (IPAC)
Infectious Diseases Society of America (ISDA)
International Union Against Sexually Transmitted Infections (IUSTI)
Public Health Ontario
Society of Infectious Diseases Pharmacists (SIDP)
UW Health (University of Wisconsin Hospitals and Clinics)