Antibiotic awareness week: a time to reflect on how we prescribe

In May, 2015, the World Health Organisation (WHO) released its global action plan on antimicrobial resistance, with the aim of ensuring that antimicrobial medicines are used responsibly so that we have an ongoing ability to successfully and safely treat infectious disease.¹ WHO sees healthcare workers as having a key role in assisting with this task. The New Zealand Health Strategy also acknowledges this issue as a global challenge.² The antimicrobial resistance action planning group, a collaboration between the Ministry of Health and the Ministry for Primary Industries, published its Antimicrobial Resistance Action plan in August, 2017.³ This plan will be implemented over the next five years and is being steered by a national co-ordination group, who will provide independent advice on the delivery of the objectives in the action plan. This group includes a representative from bpac^nz.

On a global scale, New Zealand is a relatively high user of antibiotics. Inappropriate use of antibiotics, particularly for acute upper respiratory tract infections, continues to increase the development of antibiotic resistant bacteria, the risk of adverse effects and health care costs.⁴

Primary health care professionals in New Zealand need to be proactive about antimicrobial stewardship: this aims to limit the use of antibiotics to situations where they deliver the greatest clinical benefit. Along with infection control, this is the key strategy to counter the emerging threat of antimicrobial resistance. A combination of approaches is required to change behaviour, for both clinicians and patients.

Consider strategies such as:^5-7

• When a viral infection is suspected, explain why an antibiotic is not justified, provide good advice about symptomatic management and give an idea of the time course for the particular self-limiting infection
• Manage patient expectations – reassure patients that they made the right decision to seek assessment and just because they do not require an antibiotic, it does not mean that their symptoms are not legitimate
• Involve patients in decisions about their health care and as part of this provide education about the issue of antimicrobial resistance, and not only what this means for them, but the community as a whole
• Promote preventative measures for good health – smoking cessation, healthy diet and lifestyle, the principles of good hygiene and infection control measures
• In most cases, only prescribe antibiotics for bacterial infections if:
  • Symptoms are significant or  severe
  • There is a high risk of complications
  • The infection is not resolving or is unlikely to resolve
• Balance the risks and benefits of antibiotic use for individuals – is there a risk of not using an antibiotic for that individual, at that time
• If prescribing, choosing the right antibiotic, at the right dose, for the right length of time
• Write an entry in the notes explaining your decision to prescribe an antibiotic
• Consider the use of a delayed prescription, i.e. only to be used/collected if symptoms persist or worsen
• Compare your prescribing to your peers

For further bpac^nz resources on antimicrobial stewardship and antibiotic prescribing, see:

• “Antibiotics: choices for common infections” www.bpac.org.nz/antibiotics/guide.aspx and the companion article, “The bpac^nz antibiotic guide: 2017 edition” www.bpac.org.nz/2017/abguide.aspx
• Antibiotic resistance and stewardship publication category: www.bpac.org.nz/category.aspx?CategoryId=53

1. WHO. Global action plan on antimicrobial resistance. World Health Organisation. May, 2015. Available from http://apps.who.int/iris/bitstream/10665/193736/1/9789241509763_eng.pdf?ua=1
2. Minister of Health 2016. New Zealand Health Strategy: Future direction. Wellington: Ministry of Health. Available from www.health.govt.nz (Accessed Jul, 2016).
3. Ministry of Health. New Zealand antimicrobial resistance action plan. 2017. Available from: www.health.govt.nz/publication/new-zealand-antimicrobial-resistance-action-plan
4. Meeker D, Linder JA, Fox CR et al. Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices. A Randomized Clinical Trial. JAMA 2016;315(6):562-70.
5. Harrison L. Stopping antibiotic overprescribing: what works? Medscape, June 21, 2016. Available from www.medscape.com (Accessed Jul, 2016).
6. Gerber JS. Improving outpatient antibiotic prescribing: Another nudge in the right direction. JAMA 2016;315(6):558-9
7. Meeker D, Linder JA, Fox CR et al. Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices. A Randomized Clinical Trial. JAMA 2016;315(6):562-70.

Published: 14 November 2017