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Primary Care Antimicrobial Update Steve McCormick Lead Antimicrobial Pharmacist NHS Lanarkshire Antimicrobial use is National priority • Scottish Antimicrobial Prescribing Group • Local Antimicrobial Management Team • Healthcare Environment Inspectorate Stewardship: Prudent Prescribing • Is an antibiotic required? – Only use when clearly indicated • Document decision making Tx rationale clear • Select appropriate agent from local antimicrobial policy – Minimise risk to patient • Prescribe optimal dosage for shortest duration • Ask specialist/micro for advice if unsure Firm Antimicrobial Stewardship Role of the AMT – Primary care • Link in with Primary Care Prescribing Advisers who monitor prescribing using PRISMS • Engage individual prescribers by feeding back meaningful data to promote reflection & discussion in order to influence future prescribing and promote compliance with policy • Improve quality and reduce quantity of antimicrobial prescribing Risk of C. difficile infection High Risk Medium Risk Low Risk Clindamycin Ampicillin/Amoxicillin Aminoglycosides Cephalosporins Co-trimoxazole Metronidazole Fluoroquinolones Co-amoxiclav Macrolides Tetracyclines Trimethoprim Rifampicin Tazocin Vancomycin SAPG Report on Antimicrobial Use and Resistance in Humans in 2010 Available from: http://www.isdscotland.org/HealthTopics/Prescribing-andMedicines/Publications/2012-01-31/2012-0131-SAPG-Report.pdf?81026858092 NHS Scotland: use of antibiotics associated with a higher risk of Clostridium difficile infection in primary care, items/1000/day, 2008 – 2011 Items/1000pop/day 0.50 0.40 0.30 0.20 0.10 0.00 2008 2009 2010 Year 2011 NHS Scotland: use of recommended antibiotics in primary care, items/1000/day, 2008 – 2011 1.8 Items/1000pop/day 1.7 1.6 1.5 1.4 1.3 1.2 2008 2009 2010 Year 2011 NHS Scotland: % seasonal variation of fluoroquinolones by NHS Board, (DDDs) 2008-09 – 2010-11 25 15 2008-09 5 2009-10 -5 2010-11 -15 Target -25 -35 NHS Board NHS Western Isles NHS Tayside NHS Shetland NHS Orkney NHS Lothian NHS Lanarkshire NHS Highland NHS GG & C NHS Grampian NHS Forth Valley NHS Fife NHS D & G NHS Borders -45 NHS A & A % seasonal variation (DDDs) 35 CEL 11 (2009) Seasonal Variation in use of quinolones. No more than 5% higher in winter than preceding summer by 2011. NHS Scotland: total use of antibacterials in primary care 1995-2011 22.0 Total Use 2011 2.8 2.6 4.1% higher than 2010 (items/1000/day) 2.4 2.2 18.0 2.0 1.8 16.0 1.6 1.4 14.0 1.2 12.0 1.0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 DDD/1000/day Items/1000/day Items/1000/day DDD/1000/day 20.0 = 162,000 more items 5.8% increase in DDD/1000/day (higher doses) NHS Scotland: use of antibiotics in primary care by NHS Board, Items/1000/day, 2006-07 – 2010-11 Primary Care Antibiotic Indicator: Reduce volume of antibiotic scripts by 20% NHS Scotland: Distribution of antibiotic use in GP practices (items/1000 patients/day) April 2010 - March 2011. 0 Infection Number of consultations by infection Number of consultations Otitis externa Pyelonephritis Impetigo UTI male Community acquired pneumonia COPD Otitis media Cellulitis Rhinosinusitis, acute Other UTI female Pharyngitis/sore throat/tonsillitis Acute cough/bronchitis Number of consultations 600 500 80% 400 70% 60% 300 50% 200 40% 30% 100 Cumulative total SAPG audit of management of commonly encountered infection in primary care 100% 90% 20% 10% 0% Cumulative % Stemming the tide of antibiotic resistance (STAR). A blended learning programme addressing appropriate antibiotic prescribing in general practice. Dr Sharon Simpson Associate Director, South East Wales Trials Unit, Cardiff University. BMJ 2012 http://www.stemmingthetide.org/ Booklet to use during the consultation & share with patients Francis et al BMJ 2010