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AMS PORTAL

Introduction

The AMS Portal signposts resources and information to promote learning about antimicrobial stewardship (AMS) and antibiotic resistance. 

The Portal will focus on GB resources for pharmacists and pharmacy teams and within each section we have identified key resources to support pharmacy practice within GB.  We recognise however the need to signpost worldwide information and resources from outside GB are also included as additional links.  We aim to continuously develop the AMS Portal to be accessible across all healthcare professions, encouraging a multidisciplinary and collaborative approach for improvement of antimicrobial use.

The AMS Portal is intended as a dynamic ‘living’ resource which is constantly revised and updated.  We welcome suggestions for additional content for inclusion or editing. Please submit information (links, events, courses, narrative, etc.) and we will edit and include where appropriate.

Email: [email protected]

Acknowledgements

This resource was originally launched in 2015 as amsportal.org which was collaboratively developed by the Royal Pharmaceutical Society and University College London.  For the 2017 RPS AMS campaign the resource has been extensively revised and redesigned and hosted on the RPS website.

Strategy, policy and guidance

The RPS policy, ‘The Pharmacy contribution to antimicrobial stewardship’ focuses on the pharmacist’s role as part of a multidisciplinary approach in tackling the challenges of inappropriate use of antibiotics. The recommendations in the policy have been produced in order to contribute to wider efforts in meeting the challenge set by the UK Government in 2016 of reducing inappropriate antibiotic prescribing by 50% by 2020.

The policy, along with other RPS resources aim to complement recommendations made by the Pharmaceutical Group of the European Union (PGEU) and the International Pharmaceutical Federation (FIP) in the global fight against antimicrobial resistance (AMR).

An overview of all UK AMR strategy and policy can be found on the Government website as the ‘Antimicrobial Resistance Collection’.  Included in the collection is a link to Public Health England’s ‘Antimicrobial Resistance: resource handbook’, which, at 49 pages, provides a detailed overview of national policy, guidance and supporting materials on AMS.

Details of these and other organisations who play a key role in AMR strategy policy and guidance are signposted below.

World Health Organisation (WHO) World Health Organisation (WHO)

Global Action Plan on Antimicrobial Resistance

WHO identified five strategic objectives to reduce antimicrobial resistance as part of an international action plan.

The World Health Organisation publish a 'Library of National Action Plans' and also a manual to support countries to develop their own national action plan.

Other key WHO antimicrobial resources include:

Further resources are available on the WHO website.

European Commission European Commission

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.

International Pharmaceutical Federation (FIP) International Pharmaceutical Federation (FIP)

Fighting antimicrobial resistance - the contribution of pharmacists

This report includes data on the consumption of antibiotics across EU/EEA countries, identifies gaps in research and development, and looks at how community and hospital pharmacies can contribute to the fight against AMR.

Other resources from FIP include: Control of Antimicrobial Medicines Resistance (AMR)  

Pharmaceutical Group of European Union (PGEU) Pharmaceutical Group of European Union (PGEU)

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 PGEU. 

For information on PGEU AMR activity see PGEU website.

UK Government UK Government

Antimicrobial Resistance Resource Handbook. Public Health England. 

This extensive resource, updated every six months, contains links to policy and guidance relevant to all health professionals.

Tackling Drug-Resistant Infections Globally (Review on Antimicrobial Resistance) 

This review, commissioned by the UK Government and the Wellcome Trust, makes 10 key recommendations covering three core strategies: to reduce demand for antimicrobials, to increase the number of effective antimicrobial drugs to treat resistant disease, and to build a coalition for action.

Antimicrobial Resistance (AMR): Collection 

A collection of Government department resources covering strategic publications, clinical or technical guidance and publications, resources for healthcare professionals, resources for livestock professionals, research, and news items.

Includes:

UK 5 Year Antimicrobial Resistance Strategy 2013 to 2018. Department of Health; also progress reports from 2014 and 2015

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 

Immunisation: Collection. Public Health England

A collection of Government department resources covering vaccine programmes, childhood immunisation schedules, immunisation leaflets and guidance for parents, and immunisation training resources for healthcare professionals.

Antimicrobial prescribing and stewardship competencies (2013) (Public Health England)

Royal Pharmaceutical Society (RPS) Royal Pharmaceutical Society (RPS)

The Pharmacy Contribution to Antimicrobial Stewardship 

Policy document which focuses on the pharmacist’s role as part of a multidisciplinary approach in tackling the challenges of inappropriate use of antibiotics.

Antimicrobial Stewardship: Quick Reference Guide 

Quick reference guide looking at how pharmacists and their teams working in community pharmacy can contribute to AMS.

Handwashing - essential guide

Guidance, including a step-by-step image guide on effective handwashing as a simple infection control measure.

Other relevant resources include:

Competency Framework for all Prescribers 

Includes as competency 2.10: ‘Understands antimicrobial resistance and the roles of infection prevention, control and antimicrobial stewardship measures’.

National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence (NICE)

Antimicrobial stewardship: Quality Standard 121 

Antimicrobial stewardship: changing risk-related behaviours in the general population: NICE Guideline 63 

Includes recommendations for community pharmacy teams.

Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use: NICE Guideline 15 

Includes recommendation on antimicrobial stewardship programmes and antimicrobial prescribing.

Antimicrobial stewardship: prescribing antibiotics: NICE Key Therapeutic Topic KTT9 

This document summarises the evidence base and prescribing data on antimicrobial stewardship.


NICE also produce guidelines on clinical issues which are relevant for AMS such as:

NICE Guideline 51: Sepsis: recognition, diagnosis and early management


See ‘Clinical guidelines’ below for further information on NICE resources.

Health Protection Scotland Health Protection Scotland

Compendium of HAI guidance 

The Health Protection Scotland web resource, ‘Compendium of Healthcare Associated Infection (HAI) guidance’ includes a section signposting to relevant AMS resources.


The Health Protection Scotland website also contains a section specifically on antimicrobial resistance.

Public Health Wales Public Health Wales

Scottish Antimicrobial Prescribing Group (SAPG) Scottish Antimicrobial Prescribing Group (SAPG)

Veterinary strategy, policy and guidance Veterinary strategy, policy and guidance

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

Additional Worldwide resources Additional Worldwide resources

Clinical (or technical) guidance

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. 

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).

The links below signpost either to collections of clinical and technical guidance or to guidance on a specific clinical or technical area to inform and support AMS strategies.

UK Government UK Government

Infectious diseases

Links to collections of resources covering over 100 infectious diseases such as Acinetobacter, Clostridium difficile, fungal infections, gastrointestinal infections, norovirus, respiratory virus and rotavirus.

Primary Care Guidance: Diagnosing and managing infections: collection. Public Health England 

Collection of guidance documents for health professionals in primary care covering the diagnosis of infections and the appropriate use of antimicrobials.

Clostridium difficile: guidance, data and analysis: collection. Public Health England 

Collection of resources covering the diagnosis, management and epidemiology of Clostridium difficile.

Standards for microbiology investigations: collection. Public Health England 

Collection of UK Standards for Microbiology Investigations (SMIs).

Care homes: infection prevention and control. Department of Health/Public Health England 

Specific clinical/technical guidance Specific clinical/technical guidance

British HIV Association (BHIVA)

Publish a series of clinical guidelines for the management of diseases in HIV-infected patients.

British Infection Association (BIA)

BIA produce guidelines on the management of various infections as well as signposting to relevant guidelines from other organisations.

British Thoracic Society 

BTS guidelines include community acquired pneumonia and pandemic flu.  The site also signposts to other guidance such as the NICE guidelines.

Children’s HIV Association (CHIVA)

CHIVA publish a number of guidelines including 'Immunisation', 'TB-HIV coinfection', and 'Unwell child with HIV'.

Health Protection Scotland

The Health Protection Scotland web resource, ‘Compendium of Healthcare Associated Infection (HAI) guidance’ includes a section signposting to relevant AMS clinical and technical guidelines.

Scottish Antimicrobial Prescribing Group (SAPG)

SAPG produce a range of resources to support AMS in the management of infections such as urinary tract infection, skin and soft tissue infection, community acquired pneumonia and sepsis.

Scottish Intercollegiate Guidelines Network (SIGN)

Produce a series of national clinical guidelines for Scotland.  

Initiatives and campaigns

The World Health Organisation World Antibiotics Awareness Week (WAAW) occurs each year in November.  The theme for the 2017 event, from 13-19 November, is 'Seek advice from a qualified healthcare professional before taking antibiotics'. 

European Antibiotics Awareness Day (EAAD) occurs on 18 November 2017 as part of World Antibiotics Awareness Week. 

An overview of the key messages for WAAW and EAAD 2017 can be found on the Public Health England (UK Government) website.  Further information and resources for GB practitioners is available from Antibiotic Guardian and also the  UK Government website. 

Links to information on campaigns in other European countries: Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain and Sweden, can be found on the European Centre for Disease Prevention and Control website.

For other countries see World Health Organisation.

Keep Antibiotics Working, launched by Public Health England in October 2017, is a national campaign across England supported by television advertising.  

Details of other AMS initiatives and campaigns can be found below:

AMS initiatives and campaigns AMS initiatives and campaigns


Antibiotic Action (British Society for Antimicrobial Chemotherapy) 

Established by BASC 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.

AntibioticGuardian

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 (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.


Patient focused initiatives and campaigns Patient focused initiatives and campaigns

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)

Do Bugs Need Drugs (Canada)

Get Smart: Know When Antibiotics Work  (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 initiatives and campaigns Sepsis initiatives and campaigns


Sepsis Awareness - Health Education England

Sepsis - Public Health England

Surviving Sepsis Campaign - Society of Critical Care Medicine

Think Sepsis - Health Education England

Training and educational resources

In this section we will signpost to education and training resources on AMS and sepsis.  We have not included links to training on clinical aspects of AMS such as disease management (although several of the providers we have linked also provide such training).

Other sources of relevant education and training resources include national organisations and Royal Colleges.

For those interested in postgraduate courses such as diplomas or masters, or considering studying for an MPhil or PhD, opportunities exist in AMS relevant fields such as for example: infection and immunity, bacterial pathogenesis, biomedical science, clinical microbiology, molecular biology and pathology of viruses.  Further information can be found on individual university websites.

For pharmacists looking for resources to support their professional development journey as part of the RPS Faculty see ‘Infection and Antimicrobial Stewardship: Expert Professional Practice Curriculum’.

Public Health England has produced guidance on ‘Antimicrobial prescribing: resources for professional development and practice’.

Those courses or training providers which are RPS endorsed or accredited are marked *.  If you are interested in submitting a training resource for RPS endorsement or accreditation please see here.

Training for pharmacists and pharmacy teams Training for pharmacists and pharmacy teams

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

‘Reducing Antimicrobial Resistance’.

'Think Sepsis – Sepsis in Primary Care’*.

An overview of all education and training on antimicrobial stewardship supported by Health Education England can be found in the ‘AMR and Sepsis Factsheet’. 

Future Learn (University of Dundee / BSAC)

Online course: ‘Antimicrobial Stewardship – Managing Antibiotic Resistance’.

Health E-Learning and Media (HELM) Team (University of Nottingham)

‘Sepsis and Sepsis Six’ is an e-learning package.

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 has hosted several webinars on antibiotic prescribing and antimicrobial stewardship:

Antibiotic prescribing: Back to basics.  Presented David Sharpe, Antimicrobial Pharmacist, Alder Hey Children's NHS Foundation Trust.

Antimicrobial stewardship for the non-specialist.  Presented by Jacqueline Sneddon, Project Lead for Scottish Antimicrobial Prescribing Group, Glasgow.

Antimicrobials and new local guidelines.  Presented by Karine Nash, lead primary care pharmacist, NHS Surrey.

Wales Centre for Pharmacy Professional Education (WCPPE)

Online learning resources on: ‘Antimicrobials and infection management’ and ‘Antimicrobial stewardship and resistance’.

Scottish Antimicrobial Prescribing Group (SAPG)

In collaboration with NHS Education for Scotland, SAPG has developed a range of training materials on antimicrobial stewardship.

Royal College of General Practitioners (RCGP)

The ‘TARGET Antibiotic Toolkit’ includes a series of seven webinars available as AMS e-learning resources.

Worldwide training resources Worldwide training resources

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’.

Other training and educational resources (e.g. schools, nurses) Other training and educational resources (e.g. schools, nurses)

e-Bug

Free educational resource for KS1 age to young adults teaching about microbes and antibiotics.

e-Learning for Healthcare: Health Education England

‘Reducing Antimicrobial Resistance’ is suitable for all staff working in health and social care

Fungi 4 Schools

Mycology teaching resources for teachers of children from KS2 to post-16.

Future Learn (University of Dundee / BSAC)

Online course suitable for members of the public: ‘Antimicrobial Stewardship – Managing Antibiotic Resistance’.

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.

NHS Education for Scotland (NES)*

Antimicrobial stewardship workbook aimed at nurses and midwives.

Journals

The number of articles published each year on 'antibiotic resistance' and 'antimicrobial stewardship' increases significantly each year.  A quick search of the RPS EBSCO databases for antimicrobial stewardship and antibiotic resistance related articles showed a rise year-on-year from 2661 in 2008 to 8212 (and rising) for 2017 as illustrated in the chart below.

AMS-graph

One way to ensure that you don’t miss any new research or recently published articles on antimicrobial stewardship or antibiotic resistance is to set up an automatic alert.  RPS members can set up, through the RPS Library, an email alert service which will provide updates and information on additions to selected databases such as MEDLINE and CINAHL for personal research.  A series of webinars on the RPS website provide help in systematic reviews, searching for evidence, and using the EBSCOhost databases.

There are journals, e.g. Lancet Infectious Diseases, which provide an email alert service to which you can register, this is a useful way to keep updated on AMS issues. 

Alternatively, some organisations regularly update their website with collections of newly published articles or research on antimicrobial stewardship or antibiotic resistance; e.g British Society for Antimicrobial Chemotherapy (BSAC), the Center for Infectious Disease Research and Policy (CIDRAP) or ESCMID elibrary and databases.

If you are searching for journals or evidence as part of a research project, need help with a literature review, or are interested in getting involved in research see the RPS Research and Evaluation Hub for information on resources available.

Journals Journals

Pharmaceutical Journal (PJ)

Published by the RPS, the PJ provides information and analysis on the latest advances in any branch of pharmacy practice and pharmaceutical science throughout the world. Articles include:

AMR: time is running out, we need action now

AMR and diagnostics: pointing the way to better infection control

Journal of Antimicrobial Chemotherapy

Published monthly, the Journal of Antimicrobial Chemotherapy is a journal of the British Society for Antimicrobial Chemotherapy.  It features original articles on the laboratory aspects and clinical use of antimicrobials including antibacterial, antiviral, antifungal, and antiprotozoal agents.


Also:

American Journal of Infection Control (AJIC)

British Medical Journal (BMJ)

Clinical Microbiology and Infection (CMI)

Clinical Pharmacist

International Journal of Antimicrobial Agents

Journal of Infection

Lancet Infectious Diseases

New England Journal of Medicine (NEJM)

PubMed

South African Medical Journal (SAMJ)

Organisations

In this section we have listed all the organisations mentioned in this resource.  Additionally we have signposted to other organisations who contribute to antimicrobial stewardship and/or the appropriate use of antibiotics; this includes organisations who focus on infection management, research, microbiology, clinical disease specialists, government and international agencies, professional networks, and charities.

Organisations are listed alphabetically in each section.

Where international organisations are based in a particular country this is indicated after their name.  Note however, that support provided by these organisations may be relevant outside the stated host country.

UK based organisations UK based organisations

International organisations International organisations

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

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