The Path of Least Resistance: Main Report | National Resource for Infection Control (NRIC)

The Path of Least Resistance: Main Report

Best practice, Government report, Policy, Review
Abstract: 
The report was produced by SMAC as a result of growing concerns about increasing resistance to antimicrobial drugs. There is acknowledgement that the majority of the population may take antibiotics at some time during their lives and that doctors are often pressured into prescribing antibiotics inappropriately due to patient expectations. The report looks at antimicrobial agents and the basis and extent of resistance in the UK and internationally, where antimicrobial resistance may have the greatest impact, prescribing, prevention and good practice, development of antimicrobial agents, surveillance and research. An independent literature review was undertaken and research was critically appraised and graded. The report outlines examples of situations in which resistance to antimicrobial drugs can be minimised in primary and secondary care and in veterinary practice. Recommendations are made which include the recognition that decisions are often complex, and innovative approaches to tackle the problems are included. Recommendations include information on: - - Prescribing in the community - Prescribing in hospitals - Prescribing guidelines - International co-operation - Surveillance of resistance - Research - Education - Hygiene, infection control and cross infection - Veterinary and agricultural use - Implications for industry The main recommendations are that the public and the medical profession must respect the appropriate use of antibiotics so that they remain a valuable resource.
Authors: 
Standing Medical Advisory Committee (SMAC) Sub-group on Antimicrobial Resistance.
Category: 
Control
Epidemiology
Management
Prevention
Treatment

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Summary:
The report was produced by SMAC as a result of growing concerns about increasing resistance to antimicrobial drugs. There is acknowledgement that the majority of the population may take antibiotics at some time during their lives and that doctors are often pressured into prescribing antibiotics inappropriately due to patient expectations.The report looks at antimicrobial agents and the basis and extent of resistance in the UK and internationally, where antimicrobial resistance may have the greatest impact, prescribing, prevention and good practice, development of antimicrobial agents, surveillance and research.An independent literature review was undertaken and research was critically appraised and graded.The report outlines examples of situations in which resistance to antimicrobial drugs can be minimised in primary and secondary care and in veterinary practice. Recommendations are made which include the recognition that decisions are often complex, and innovative approaches to tackle the problems are included. Recommendations include information on: - Prescribing in the community Prescribing in hospitals Prescribing guidelines International co-operation Surveillance of resistance Research Education Hygiene, infection control and cross infection Veterinary and agricultural use Implications for industryThe main recommendations are that the public and the medical profession must respect the appropriate use of antibiotics so that they remain a valuable resource.
Questions Addressed:
'The aim of the report was to produce recommendations that could constitute the first phase of a national strategy for minimising the increasing development of antimicrobial resistance' The report provides recommendations on how to achieve this aim.
Type of Study:
Independent review of the literature to determine whether changing prescribing patterns could result in reduction/limitation of the spread of antimicrobial resistance, Policy guidance
Methods Valid:
Yes
Methods Valid Detail:

Following the report The National Steering Group (NSG) was charged with establishing small groups of experts to expedite the recommendations and report to the Chief Medical Officer (CMO) within a year on progress made. The CMO would then consider asking SMAC to reconvene the subgroup to develop the next phase of the strategy

Results Reliability:
The quality of the research from the independent review was critically appraised and graded using a modified version of the criteria developed in the NHS Centre for Reviews and Dissemination, University of York in conjunction with the Cochrane Collaboration. In general the quality of the evidence was not high, there was difficulty in adapting scoring schemes devised for clinical trials and the time limits caused difficulties. Many papers were non-systematic reviews, conference reports and editorial comments rather than original studies with the exception of those in the field of guideline implementation. (Randomised controlled trials and systematic reviews)
Problems or Biases:

Lack of systematic reviews and randomised controlled trials in some areas due to ethical issues and paucity/quality of evidence

Relevant Studies:

1. Select Committee on Science and Technology. Fighting Infection (2003) http://www.publications.parliament.uk/pa/ld200203/ldselect/ldsctech/138/.... Optimising Clinical Use of Antimicrobials (2001) http://www.dh.gov.uk/assetRoot/04/06/56/22/04065622.pdf3. UK Antimicrobial Resistance Strategy and Action Plan. (2000) http://www.dh.gov.uk/assetRoot/04/07/84/48/04078448.pdf4. Science summit: harnessing science to combat healthcare associated infection 15th & 16th December 2004 http://www.dh.gov.uk/assetRoot/04/10/64/32/04106432.pdf 5. Winning Ways – working together to reduce healthcare acquired infection. Report from the CMO (December 2003)

Keywords:
antimicrobial resistance antimicrobial agents antiviral agents antifungal agents prescribing selection pressure side effects
Reviewer Name:
Sue Wiseman
Reviewer Post:
Nurse Consultant –Infection Control, DH
Reviewer Affiliations:
Member Advisory Committee on Dangerous Pathogens Health Protection Adviser Royal College of Nursing P/T Member Infection Control Nurses Association