Point-of-care testing for infections vital in fight against antimicrobial resistance
Antimicrobial pharmacist Philip Howard tells conference how point-of-care tests could reduce inappropriate prescribing of antibiotics.
Source: Nadia Attura
Point-of-care tests are one of the most crucial developments in the fight against antimicrobial resistance, according to Philip Howard, consultant antimicrobial pharmacist at Leeds Teaching Hospital.
Speaking at the Royal Pharmaceutical Society annual conference on 13 September 2015, Howard told attendees that prescriptions for viral respiratory tract infections were the main source of inappropriate prescribing. A point-of-care test that can distinguish between viral and bacterial infections would make a big difference to prescribing behaviour, he said, especially when persuading patients that antibiotics are unnecessary.
One study found that the use of procalcitonin testing can reduce antibiotic prescribing by 40% in secondary care, added Howard. However, the tests were not recommended in the recent guideline on antimicrobial stewardship issued by National Institute for Health and Care Excellence (NICE) in August 2015.
At the launch of the guideline, Mark Baker, NICE director of clinical practice, suggested that doctors could be referred to their professional regulator for inappropriate antibiotic prescribing. Howard, who was on the NICE review group for the guideline, said the comments were unfortunate because they did not relate to recommendations within the guideline. Instead, Howard believes that using targets to reduce inappropriate antibiotic prescribing is a better approach. “Targets work, there’s been an 80% reduction in Clostridium difficile infections,” he said. “If you can do it by a global approach rather than targeting the individual so they feel pressurised, I think that’s a better way to do it.”
Current UK targets aim to reduce antibiotic prescribing by 1% across care settings and by 10% for broad spectrum antibiotics in primary care. Howard said this approach is starting to work because the number of clinical commissioning groups meeting the target is steadily increasing. However, he highlighted that the UK is still one of the most prolific antibiotic prescribers in Europe.
Another suggestion made by Howard is that prescriptions for antibiotics have the indication written on them, so that community pharmacists can question whether a prescription is appropriate.
One of the biggest bacterial killers is sepsis, claiming 37,000 lives a year in the UK. But there are 102,000 cases of sepsis a year and, if antibiotics become ineffective, almost all of these people will die, said Howard. Yet many community pharmacists do not know the signs of sepsis and early intervention with antibiotics is crucial. “We need a community pharmacy toolkit to help identify patients with sepsis,” he recommended.
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20069352
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