Okay, now I’ve been pretty critical of the NICE guideline “Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use” I probably should put my money where my mouth is and see if I can do any better… I believe that any guideline should try to follow SMART principles (Specific, Measurable, Realistic, Achievable and Timed) and they should also where possible be evidence–based or at least expert opinion guided and free from bias or conflicts of interest.
There isn’t a huge amount of good quality evidence to support antimicrobial stewardship as acknowledged by NICE however; I feel this is one of those areas where absence of evidence doesn’t constitute evidence of absence. I think antimicrobial stewardship is just about good practice in regards to the correct use of antimicrobials and the management of infections. My conflict of interest is that I have written a pocket book “Microbiology Nuts & Bolts” which is available from Amazon and aims to educate all levels of doctors how to diagnose the right infection and prescribe the right antimicrobial, at the right dose, route and duration.
I have not split private providers from NHS providers as I believe the guideline should be adopted equally across both areas. For my guideline, if the private provider provides acute hospital care they should be regarded as an acute Trust, if they provide private primary care then they should be regarded as a primary care practice.
In my opinion there are 7 key areas for implementation in this guideline:
1. The Antimicrobial Stewardship Team
2. Antimicrobial Stewardship Groups
3. Education
4. Empirical Antimicrobial Guidelines
5. The Antimicrobial Ward Round
6. Audit
7. Pathology Services
The guideline is 5 pages long so I've created a PDF called "Antimicrobial Stewardship Guideline" which you can download. There is no copyright on this information so if you find it useful please feel free to use and distribute it as required.
Is THIS guideline fit for purpose?
I’ve done my best to specify the requirements I believe are necessary for good antimicrobial stewardship in the context of a SMART guideline but do you agree? Would you do anything differently? Do you think this is too prescriptive to healthcare providers or do you think clear instruction which avoids words like “consider” and “could” is clearer and more helpful? Antimicrobial stewardship is often imposed upon clinical services in a manner suggesting it is the “antibiotic police”. I believe clinical specialities should be embracing this opportunity to develop their expertise and become champions of infection within their speciality. I believe a general surgeon should be the expert in peritonitis, an orthopaedic surgeon in joint infections, a neurologist in meningitis and a cardiologist in endocarditis etc. I do not feel microbiologists should be telling others how to manage common infections within their speciality, although I love helping when it comes to the weird and wonderful. But what do you think? Let me know.
In my opinion there are 7 key areas for implementation in this guideline:
1. The Antimicrobial Stewardship Team
2. Antimicrobial Stewardship Groups
3. Education
4. Empirical Antimicrobial Guidelines
5. The Antimicrobial Ward Round
6. Audit
7. Pathology Services
The guideline is 5 pages long so I've created a PDF called "Antimicrobial Stewardship Guideline" which you can download. There is no copyright on this information so if you find it useful please feel free to use and distribute it as required.
Is THIS guideline fit for purpose?
I’ve done my best to specify the requirements I believe are necessary for good antimicrobial stewardship in the context of a SMART guideline but do you agree? Would you do anything differently? Do you think this is too prescriptive to healthcare providers or do you think clear instruction which avoids words like “consider” and “could” is clearer and more helpful? Antimicrobial stewardship is often imposed upon clinical services in a manner suggesting it is the “antibiotic police”. I believe clinical specialities should be embracing this opportunity to develop their expertise and become champions of infection within their speciality. I believe a general surgeon should be the expert in peritonitis, an orthopaedic surgeon in joint infections, a neurologist in meningitis and a cardiologist in endocarditis etc. I do not feel microbiologists should be telling others how to manage common infections within their speciality, although I love helping when it comes to the weird and wonderful. But what do you think? Let me know.
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