AMS Portal

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Introduction

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

The Portal focuses on resources to support pharmacy practice within GB. We recognise the need to signpost worldwide information and therefore 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.

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]

Strategy, policy and guidance

Our 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. Along with other RPS resources, our policy aims to help meet the challenges outlined in the UK Government AMR action plans (published every 5 years) and complement recommendations made by the International Pharmaceutical Federation (FIP) and the Pharmaceutical Group of the European Union (PGEU).

We frequently respond to consultations from the government, regulatory bodies and other healthcare and professional bodies on AMR/AMS, infection prevention and management and other related issues to ensure that pharmacy has a clear, strong voice in all discussions. Our aim is to ensure that the views of members and experts within the profession are reflected in our responses, therefore we work in partnership with our Antimicrobial Expert Advisory Group (AmEAG) and other expert groups to provide a coordinated response to these consultations where appropriate.

RPS Policy: The Pharmacy Contribution to Antimicrobial Stewardship

Our policy focuses on the role of pharmacists as part of a multidisciplinary approach in tackling the challenges of inappropriate use of antibiotics.

Antimicrobial Stewardship: Quick Reference Guide

Our quick reference guide looks at how pharmacists and their teams work 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.

RPS Antimicrobial Expert Advisory Group (AmEAG)

Our AmEAG works closely with our Boards and other groups to advise on resistance, infection prevention and management, and any other issues that might affect the pharmacy profession and the public.

Following the 2017 United nations Declaration, a summary of the roundtable - 'Call to Action on Antimicrobial Resistance' - was prepared by the Department of Health. During the discussion 10 underpinning principles were agreed.

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

UK Government UK Government

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

England, Scotland and Wales England, Scotland and Wales

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).

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

The Global Action Plan on Antimicrobial Resistance Practical toolkit to support antimicrobial stewardship programmes in health-care facilities in low and middle income contriesidentified five strategic objectives to reduce AMR as part of an international action plan.

The 'Library of National Action Plans' and also the AMR manual support countries to develop their own national action plan.

Other key WHO resources include:

Further resources are available on the WHO website.

Other worldwide organisations and resources Other worldwide organisations and resources

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)

European Commission and other European organisations European Commission and other European organisations

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

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

Initiatives and campaigns

The World Health Organisation World Antibiotics Awareness Week (WAAW) and the European Antibiotics Awareness Day (EAAD) occur in November each year. An overview of the key messages for WAAW and EAAD 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, from Public Health England, 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 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.

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)

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 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

We provide a range of educational resources to help you develop the knowledge, skills and confidence to lead AMS interventions, benefiting you, your workplace, and your patients.

England

AMS Training Programme This Health Education England funded programme runs from February 2020 until May 2020. There is one full training day, then learning time should be approximately 2-3 hours per week.

UK wide

Infection and AMS curricula Professional curriculum to support members with the knowledge, skills, experience and behaviours to advance in their practice in infection and AMS.

In this section we 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’.

Health Education England has published 'Antimicrobial resistance - a training resources guide' - a signposting guide on learning materials on antimicrobial resistance and infection for prescribers, pharmacists and other health workers and students.

In England, details of local AMR networks can provide information on any training in your areas.

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

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.

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’.

Training for prescribers Training for prescribers

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.

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.

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.

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 this chart.

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 library 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 Guide for information on resources available.

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.