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AMS PORTAL

Introduction

The AMS Portal signposts resources and information to promote learning about antimicrobial stewardship (AMS) and antibiotic resistance. 

The Portal will focus on GB resources for pharmacists and pharmacy teams and within each section we have identified key resources to support pharmacy practice within GB.  We recognise however the need to signpost worldwide information and resources from outside GB are also included as additional links.  We aim to continuously develop the AMS Portal to be accessible across all healthcare professions, encouraging a multidisciplinary and collaborative approach for improvement of antimicrobial use.

The AMS Portal is intended as a dynamic ‘living’ resource which is constantly revised and updated.  We welcome suggestions for additional content for inclusion or editing. Please submit information (links, events, courses, narrative, etc.) and we will edit and include where appropriate.

Email: [email protected]

Acknowledgements

This resource was originally launched in 2015 as amsportal.org which was collaboratively developed by the Londep and University College London.  For the 2017 RPS AMS campaign the resource has been extensively revised and redesigned and hosted on the RPS website.

Strategy, policy and guidance

The RPS policy, ‘The Pharmacy contribution to antimicrobial stewardship’ focuses on the pharmacist’s role as part of a multidisciplinary approach in tackling the challenges of inappropriate use of antibiotics. The recommendations in the policy have been produced in order to contribute to wider efforts in meeting the challenge set by the UK Government in 2016 of reducing inappropriate antibiotic prescribing by 50% by 2020.

The policy, along with other RPS resources aim to complement recommendations made by the and the International Pharmaceutical Federation (FIP) in the global fight against antimicrobial resistance (AMR).

An overview of all UK AMR strategy and policy can be found on the Government website as the ‘’.  Included in the collection is a link to Public Health England’s ‘’, which, at 49 pages, provides a detailed overview of national policy, guidance and supporting materials on AMS.

- prepared by the Department of Health, this is a summary of a roundtable 'Call to Action' following the 2017 United nations Declaration.  During the discussion 10 underpinning principles were agreed.

Details of these and other organisations who play a key role in AMR strategy policy and guidance are signposted below.

World Health Organisation (WHO) World Health Organisation (WHO)

WHO identified five strategic objectives to reduce antimicrobial resistance as part of an international action plan.

The World Health Organisation publish a '' and also a  to support countries to develop their own national action plan.

Other key WHO antimicrobial resources include:

Further resources are available on the .

European Commission European Commission

 

The 'One Health' action plan includes three main objectives: making the EU a best practice region; boosting research, development and innovation on AMR; and, shaping the global agenda.

International Pharmaceutical Federation (FIP) International Pharmaceutical Federation (FIP)

This report includes data on the consumption of antibiotics across EU/EEA countries, identifies gaps in research and development, and looks at how community and hospital pharmacies can contribute to the fight against AMR.

Other resources from FIP include:  

Pharmaceutical Group of European Union (PGEU) Pharmaceutical Group of European Union (PGEU)

The Community Pharmacy Contribution to Tackling Antimicrobial Resistance (AMR)

The role of community pharmacy in tackling AMR and encouraging the prudent use of antimicrobials is included across all of the four key recommendations by PGEU. 

For information on PGEU AMR activity see .

UK Government UK Government

. Public Health England. 

This extensive resource, updated every six months, contains links to policy and guidance relevant to all health professionals.

(Review on Antimicrobial Resistance) 

This review, commissioned by the UK Government and the Wellcome Trust, makes 10 key recommendations covering three core strategies: to reduce demand for antimicrobials, to increase the number of effective antimicrobial drugs to treat resistant disease, and to build a coalition for action.

 

A collection of Government department resources covering strategic publications, clinical or technical guidance and publications, resources for healthcare professionals, resources for livestock professionals, research, and news items.

Includes:

. Department of Health; also progress reports from 2014 and 2015

. Public Health England 

. Public Health England 

. Department of Health 

. Public Health England

A collection of Government department resources covering vaccine programmes, childhood immunisation schedules, immunisation leaflets and guidance for parents, and immunisation training resources for healthcare professionals.

 (Public Health England)

Londep (RPS) Londep (RPS)

The Pharmacy Contribution to Antimicrobial Stewardship 

Policy document which focuses on the pharmacist’s role as part of a multidisciplinary approach in tackling the challenges of inappropriate use of antibiotics.

Antimicrobial Stewardship: Quick Reference Guide 

Quick reference guide looking at how pharmacists and their teams working in community pharmacy can contribute to AMS.

Handwashing - essential guide

Guidance, including a step-by-step image guide on effective handwashing as a simple infection control measure.

Other relevant resources include:

Competency Framework for all Prescribers 

Includes as competency 2.10: ‘Understands antimicrobial resistance and the roles of infection prevention, control and antimicrobial stewardship measures’.

National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence (NICE)

 

 

Includes recommendations for community pharmacy teams.

 

Includes recommendation on antimicrobial stewardship programmes and antimicrobial prescribing.

 

This document summarises the evidence base and prescribing data on antimicrobial stewardship.


NICE also produce guidelines on clinical issues which are relevant for AMS such as:


See ‘Clinical guidelines’ below for further information on NICE resources.

Health Protection Scotland Health Protection Scotland

 

The Health Protection Scotland web resource, ‘Compendium of Healthcare Associated Infection (HAI) guidance’ includes a section signposting to relevant AMS resources.


The also contains a section specifically on antimicrobial resistance.

Public Health Wales Public Health Wales

Scottish Antimicrobial Prescribing Group (SAPG) Scottish Antimicrobial Prescribing Group (SAPG)

Veterinary strategy, policy and guidance Veterinary strategy, policy and guidance

Although not directly related to pharmacy, the use of antibiotics in agriculture and livestock production contributes to antimicrobial resistance.  Across the world, antibiotics are used in livestock production for disease prevention or growth promotion although it should be noted that the use of all growth promoters in farm animals was banned in the EU in 2006.  

An overview of the antimicrobial resistance including statistics on the use in agriculture and livestock can be found on the .

Numerous animal health organisations in the UK have issued guidance on the use of antibiotics in animals and these have been consolidated by the .

The VMD has also issued guidance on:

The  has published guidance on the '', and a position statement on ''.  Additional resources including a series of myth busters and posters for display in veterinary waiting rooms can be found on the .

The ) has published a series of  on the responsible use of antimicrobials in livestock e.g. poultry and game, pig, cattle, sheep.  Other RUMA publications include:

Additional Worldwide resources Additional Worldwide resources

(Spain)

 (United States of America)

 (United States of America)

(Kenya)

 (Canada)

Clinical (or technical) guidance

Ensuring the appropriateness of an antimicrobial prescription against the national and/or local guidelines is one of the key ways in which pharmacy in GB can contribute to AMS. 

Copies of the local antimicrobial/antibiotic formulary can be obtained from the local Area Prescribing Committee (England), Drug and Therapeutics Committee (Scotland) or Local Health Board (Wales).

The links below signpost either to collections of clinical and technical guidance or to guidance on a specific clinical or technical area to inform and support AMS strategies.

National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence (NICE)


Lower urinary tract symptoms in men: management: NICE Clinical Guideline 97


 

 

Also in development by NICE is a series of eight ‘’  covering: Catheter associated urinary tract infections, Otitis media (acute), Prostatitis (acute), Pyelonephritis (acute), Recurrent urinary tract infections, Sore throat (acute), and Urinary tract infections (lower).

UK Government UK Government

Links to collections of resources covering over 100 infectious diseases such as Acinetobacter, Clostridium difficile, fungal infections, gastrointestinal infections, norovirus, respiratory virus and rotavirus.

. Public Health England 

Collection of guidance documents for health professionals in primary care covering the diagnosis of infections and the appropriate use of antimicrobials.

. Public Health England 

Collection of resources covering the diagnosis, management and epidemiology of Clostridium difficile.

. Public Health England 

Collection of UK Standards for Microbiology Investigations (SMIs).

. Department of Health/Public Health England 

: Public Health England

Specific clinical/technical guidance Specific clinical/technical guidance


Publish a series of clinical guidelines for the management of diseases in HIV-infected patients.

BIA produce guidelines on the management of various infections as well as signposting to relevant guidelines from other organisations.

 

BTS guidelines include community acquired pneumonia and pandemic flu.  The site also signposts to other guidance such as the NICE guidelines.


CHIVA publish a number of guidelines including 'Immunisation', 'TB-HIV coinfection', and 'Unwell child with HIV'.

The Health Protection Scotland web resource, ‘’ includes a section signposting to relevant AMS clinical and technical guidelines.


SAPG produce a range of resources to support AMS in the management of infections such as urinary tract infection, skin and soft tissue infection, community acquired pneumonia and sepsis.

Produce a series of national clinical guidelines for Scotland.  

Additional worldwide resources Additional worldwide resources

 (United States of America)

 (United States of America)


(University of Wisconsin Hospitals and Clinics)

Initiatives and campaigns

The World Health Organisation World Antibiotics Awareness Week (WAAW) occurs each year in November.  The theme for the 2017 event was 'Seek advice from a qualified healthcare professional before taking antibiotics'. 

European Antibiotics Awareness Day (EAAD) occurs in November as part of World Antibiotics Awareness Week. 

An overview of the key messages for WAAW and EAAD 2017 can be found on the (UK Government) website.  Further information and resources for GB practitioners is available from Antibiotic Guardian and also the   website. 

Links to information on campaigns in other European countries: Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain and Sweden, can be found on the website.

For other countries see .

, launched by Public Health England in October 2017, is a national campaign across England supported by television advertising.  

Details of other AMS initiatives and campaigns can be found below:

AMS initiatives and campaigns AMS initiatives and campaigns


 (British Society for Antimicrobial Chemotherapy) 

Established by BASC in 2011, Antibiotic Action is a global public awareness initiative to inform about infection prevention and control, drug resistance, and the appropriate use of antibiotics.

A campaign where health or social care professionals, members of the public and students, educators or scientists can pledge to become an 'Antibiotic Guardian'.

 (Public Health England)

Aimed at secondary care, this toolkit supports the development of antimicrobial stewardship.

 (Royal College of General Practitioners)

'Treat Antibiotics Responsibly, Guidance, Education and Tools' (TARGET) is a toolkit aimed at the primary care team to support antimicrobial stewardship.  Included in the toolkit are a number of leaflets aimed at members of the public and which includes: 'Treating Your Infection - Respiratory Tract Infection' for community pharmacy.

 (NHS Bath and North East Somerset Clinical Commissioning Group)

An evidence-based system to manage the diagnosis and management of urinary tract infections in people living in care homes which has successfully reduced the inappropriate use of antibiotics.


Patient focused initiatives and campaigns Patient focused initiatives and campaigns

Advice for parents and carers on caring for children with coughs.

Support for patients on managing cough and cold symptoms.

Range of Fact Sheets for patients on topics such as fever in children, coughs, sore throat, otitis media, common cold and sinusitis.


Support for patients on managing cough and cold symptoms.


Information for parents on the management of colds, coughs, ear ache and sore throats in children.

Why Wasn't I Prescribed Antibiotics?

Advice for patients on treating common infections.


Additional Worldwide initiatives and campaigns:

 (Australia)

 (United States of America)

(Canada)

  (United States of America)

 (United States of America)

 (Association for Professionals in Infection Control and Epidemiology: occurs third full week of October each year)

(World Health Organisation - International: occurs in May each year)

(Ireland)

Sepsis initiatives and campaigns Sepsis initiatives and campaigns


 - Health Education England

 - Public Health England

 - Society of Critical Care Medicine

 - Health Education England

Training and educational resources

In this section we will signpost to education and training resources on AMS and sepsis.  We have not included links to training on clinical aspects of AMS such as disease management (although several of the providers we have linked also provide such training).

Other sources of relevant education and training resources include national organisations and Royal Colleges.

For those interested in postgraduate courses such as diplomas or masters, or considering studying for an MPhil or PhD, opportunities exist in AMS relevant fields such as for example: infection and immunity, bacterial pathogenesis, biomedical science, clinical microbiology, molecular biology and pathology of viruses.  Further information can be found on individual university websites.

For pharmacists looking for resources to support their professional development journey as part of the RPS Faculty see ‘.

Public Health England has produced guidance on ‘ which includes '' for all prescribers.

Health Education England has published '' - a signposting guide on learning materials on antimicrobial resistance and infection for prescribers, pharmacists and other health workers and students.  

Those courses or training providers which are RPS endorsed or accredited are marked *.  If you are interested in submitting a training resource for RPS endorsement or accreditation please see here.

Training for pharmacists and pharmacy teams Training for pharmacists and pharmacy teams

Distance learning resources: ‘Antibacterial resistance – a global threat to public health: the role of the pharmacy team’ and ‘Antimicrobial Stewardship’.

Also available as distance learning or a workshop:  ‘Antibacterials – focal point’.

‘Reducing Antimicrobial Resistance’.

'Think Sepsis – Sepsis in Primary Care’*.

An overview of all education and training on antimicrobial stewardship supported by Health Education England can be found in the ‘’. 

Online course: ‘Antimicrobial Stewardship – Managing Antibiotic Resistance’.  Also available in .

‘Sepsis and Sepsis Six’ is an e-learning package.

 

‘STAR: Stemming the Tide of Antibiotic Resistance’ is a short e-learning course on the concept of antibiotic resistance.

*

Facilitate local workshops on: ‘Antimicrobials in Clinical Practice’

E-learning aimed at primary care physicians.

Londep has hosted several webinars on antibiotic prescribing and antimicrobial stewardship:

Antibiotic prescribing: Back to basics.  Presented David Sharpe, Antimicrobial Pharmacist, Alder Hey Children's NHS Foundation Trust.

Antimicrobial stewardship for the non-specialist.  Presented by Jacqueline Sneddon, Project Lead for Scottish Antimicrobial Prescribing Group, Glasgow.

Antimicrobials and new local guidelines.  Presented by Karine Nash, lead primary care pharmacist, NHS Surrey.

Londep/UK Clinical Pharmacy Association 

'Building Your Confidence Around Antimicrobial Stewardship'. Learning event on 02 March 2018 aimed at pharmacists working in community or at a band 6-7 level in a hospital or GP practice setting. Further information available on the RPS website.

Online learning resources on: ‘Antimicrobials and infection management’ and ‘Antimicrobial stewardship and resistance’.

In collaboration with NHS Education for Scotland, SAPG has developed a range of training materials on antimicrobial stewardship.

The ‘TARGET Antibiotic Toolkit’ includes a series of seven webinars available as AMS e-learning resources.

Worldwide training resources Worldwide training resources

AHRQ provides a Nursing Home Antimicrobial Stewardship Guide.

CIDRAP signposts to various education and training resources worldwide.

Online course: Healthcare Epidemiology, Infection Control and Antimicrobial Stewardship

Offer an ‘Antibiotic Stewardship Programme’.

Based in the USA, SIDP offer an ‘Antimicrobial stewardship certificate program for pharmacists’.

Training for prescribers Training for prescribers

: training video for doctors-in-training.  Produced as part of a review of interventions to improve antimicrobial prescribing behaviours of doctors in training.  Original article published in .

Other training and educational resources (e.g. schools, nurses) Other training and educational resources (e.g. schools, nurses)


Free educational resource for KS1 age to young adults teaching about microbes and antibiotics.

‘Reducing Antimicrobial Resistance’ is suitable for all staff working in health and social care

Mycology teaching resources for teachers of children from KS2 to post-16.

Online course suitable for members of the public: ‘Antimicrobial Stewardship – Managing Antibiotic Resistance’.

(International Scientific Forum on Home Hygiene)

Series of training materials covering home hygiene and the home and peri-domestic settings.

Hosted by the Microbiology Society this website supports the teaching and learning of microbiology in the classroom across the key stages.

*

Antimicrobial stewardship workbook aimed at nurses and midwives.

Journals

The number of articles published each year on 'antibiotic resistance' and 'antimicrobial stewardship' increases significantly each year.  A quick search of the RPS EBSCO databases for antimicrobial stewardship and antibiotic resistance related articles showed a rise year-on-year from 2661 in 2008 to 8212 (and rising) for 2017 as illustrated in the chart below.

One way to ensure that you don’t miss any new research or recently published articles on antimicrobial stewardship or antibiotic resistance is to set up an automatic alert.  RPS members can set up, through the RPS Library, an email alert service which will provide updates and information on additions to selected databases such as MEDLINE and CINAHL for personal research.  A series of webinars on the RPS website provide help in systematic reviews, searching for evidence, and using the EBSCOhost databases.

There are journals, e.g. , which provide an email alert service to which you can register, this is a useful way to keep updated on AMS issues. 

Alternatively, some organisations regularly update their website with collections of newly published articles or research on antimicrobial stewardship or antibiotic resistance; e.g , the  or .

If you are searching for journals or evidence as part of a research project, need help with a literature review, or are interested in getting involved in research see the RPS Research and Evaluation Hub for information on resources available.

Journals Journals

Published by the RPS, the PJ provides information and analysis on the latest advances in any branch of pharmacy practice and pharmaceutical science throughout the world. Articles include:

Published monthly, the Journal of Antimicrobial Chemotherapy is a journal of the British Society for Antimicrobial Chemotherapy.  It features original articles on the laboratory aspects and clinical use of antimicrobials including antibacterial, antiviral, antifungal, and antiprotozoal agents.


Also:


Organisations

In this section we have listed all the organisations mentioned in this resource.  Additionally we have signposted to other organisations who contribute to antimicrobial stewardship and/or the appropriate use of antibiotics; this includes organisations who focus on infection management, research, microbiology, clinical disease specialists, government and international agencies, professional networks, and charities.

Organisations are listed alphabetically in each section.

Where international organisations are based in a particular country this is indicated after their name.  Note however, that support provided by these organisations may be relevant outside the stated host country.

UK based organisations UK based organisations

 


 


 

 



 (CHIVA)



)



 



 



 

)

Londep

 


 

: includes , , 

 


International organisations International organisations

 (Spain)


 (United States of America)


 (United States of America)

 (Australia)


 (France)


 (United States of America)

 (United States of America)

 (United States of America)

 (Europe)

 (United States of America)



 




 (Russia)


 (Kenya)

(Australia)

(Netherlands)


 (United States of America)

 (Canada)

 (International)

(German) 

 (United States of America)

 (Canada)

) (Sweden) 


 

 

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