The first is on safe and effective antimicrobial stewardship in relation to the use of antimicrobials in health and social care, and the second is a public health guideline that will focus on changing people’s knowledge, attitudes and behaviours in relation to the use of antimicrobials.
Last week, a report by Public Health England found that antibiotic prescriptions and cases of resistant bacteria in England have continued to rise despite continued warnings about unnecessary antibiotic use.
Public Health England found that between 2010 and 2013 there was a 6 per cent increase in the combined antibiotic prescribing of GPs and hospitals. Over the same 4-year period, antibiotic prescribing to hospital inpatients rose by 12 per cent and other community prescriptions, such as by dentists, rose by 32 per cent.
There was also an increase of 12 per cent in the number of bloodstream infections caused by E.coli with varying levels of resistance to key antibiotics for this infection of between 10 to 19 per cent.
The findings are taken from the first annual report of PHE’s English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR).
Prime Minister David Cameron has warned the world will be "cast back into the dark ages of medicine" unless action is taken.
The Chief Medical Officer for England, Professor Dame Sally Davies has said that antimicrobial resistance poses a “catastrophic threat” to the health of the nation.
Red flag’ symptoms suggesting disorders other than GOR
| Symptoms and signs | Possible diagnostic implications | Suggested actions |
|---|---|---|
|
Gastrointestinal |
||
|
Frequent, forceful (projectile) vomiting |
May suggest hypertrophic pyloric stenosis in infants up to 2 months old |
Paediatric surgery referral |
|
Bile-stained (green or yellow-green) vomit |
May suggest intestinal obstruction |
Paediatric surgery referral |
|
Haematemesis (blood in vomit) with the exception of swallowed blood, for example, following a nose bleed or ingested blood from a cracked nipple in some breast‑fed infants |
May suggest an important and potentially serious bleed from the oesophagus, stomach or upper gut |
Specialist referral |
|
Onset of regurgitation and/or vomiting after 6 months old or persisting after 1 year old |
Late onset suggests a cause other than reflux, for example a urinary tract infection (also see the NICE guideline on urinary tract infection in children) Persistence suggests an alternative diagnosis |
Urine microbiology investigation Specialist referral |
|
Blood in stool |
May suggest a variety of conditions, including bacterial gastroenteritis, infant cow’s milk protein allergy (also see the NICE guideline on food allergy in children and young people) or an acute surgical condition |
Stool microbiology investigation Specialist referral |
|
Abdominal distension, tenderness or palpable mass |
May suggest intestinal obstruction or another acute surgical condition |
Paediatric surgery referral |
|
Chronic diarrhoea |
May suggest cow’s milk protein allergy (also see the NICE guideline on food allergy in children and young people) |
Specialist referral |
|
Systemic |
||
|
Appearing unwell Fever |
May suggest infection (also see the NICE guideline on feverish illness in children) |
Clinical assessment and urine microbiology investigation Specialist referral |
|
Dysuria |
May suggest urinary tract infection (also see the NICE guideline on urinary tract infection in children) |
Clinical assessment and urine microbiology investigation Specialist referral |
|
Bulging fontanelle |
May suggest raised intracranial pressure, for example, due to meningitis (also see the NICE guideline on bacterial meningitis and meningococcal septicaemia) |
Specialist referral |
|
Rapidly increasing head circumference (more than 1 cm per week) Persistent morning headache, and vomiting worse in the morning |
May suggest raised intracranial pressure, for example, due to hydrocephalus or a brain tumour |
Specialist referral |
|
Altered responsiveness, for example, lethargy or irritability |
May suggest an illness such as meningitis (also see the NICE guideline on bacterial meningitis and meningococcal septicaemia) |
Specialist referral |
|
Infants and children with, or at high risk of, atopy |
May suggest cow’s milk protein allergy (also see the NICE guideline on food allergy in children and young people) |
Specialist referral |
Professor Mark Baker, Director of clinical practice at NICE, said: “The ESPAUR report highlights how important antimicrobial stewardship is in ensuring antimicrobials are used safely and appropriately to manage the increasing challenge of antimicrobial resistance, which is a complex issue.
“Tackling antimicrobial resistance will require a concerted and co-ordinated effort by multiple national agencies, and effective implementation of what we know works to reduce it whilst promoting antimicrobial stewardship.
“NICE is developing two guidelines which will support national efforts to reduce antimicrobial resistance. The first is on antimicrobial stewardship focussing on specific questions relating to safe and effective antimicrobial stewardship in relation to the use of antimicrobials in health and social care and seeks to understand those interventions, systems and processes that can positively influence health and social care practitioners’ decision making. This includes identifying the barriers to effective stewardship, along with reviewing the systems and processes to reduce the emergence of antimicrobial resistance.
“The second is a public health guideline that will focus on changing the public’s people’s knowledge, attitudes and behaviours in relation to the use of antimicrobials, and to educate health and social care practitioners about practices that can reduce the spread of antimicrobial resistance. Together, these complementary guidelines should help to tackle this important issue.”