Antibiotic/Antimicrobial

The following guidelines have been approved by the Barking and Dagenham, Havering and Redbridge Area Prescribing sub-Committees (APC). They have been developed in association with the relevant clinicians in both primary and secondary care, where applicable.

Please note that the Havering and Redbridge pages have been redirected here to facilitate updates.

Please note this website will be closing on the 31 August. This website (Barking and Dagenham- also Havering and Redbridge) will no longer be updated. All relevant documents will be moved to the NEL Medicines Optimisation portal

Please note: North East and North Central London Health Protection Team's updated contact details

Antimicrobial/Antibiotic guidelines

• Antimicrobial prescribing guidance for primary care
• Administration of Intravenous Antibiotics Information Sheet

Carbon-13 Urea breath tests

• Carbon-13 urea breath tests in re-testing for Helicobacter Pylori infection
• Supporting information for Carbon-13 urea breath tests

Urinary Tract Infections (UTI)

• UTI assessment tool for Care Homes
• Hydration Guidance for Care Homes

Antimicrobial Resistance

• NEL AMRSG resources are also on the SPS website 

Introduction

Antibacterial or antimicrobial resistance (AMR) is a growing reality and the NHS is required to reduce current antibiotic prescribing volumes to the levels achieved in 2010. Evidence suggests that antibiotic resistance is driven by over-using antibiotics and prescribing them inappropriately. Keeping levels of antibacterial prescribing low, by only prescribing antibiotics when appropriate, will help reduce the spread of antibacterial resistance that can be a serious threat to patients who have infections that do not respond to antimicrobial drugs. Broad spectrum antibiotics, such as Co-Amoxiclav, Cephalosporins and Quinolones, need to be reserved to treat resistant disease and should generally be used only when standard antibiotics are ineffective.

Key Tools to support GP practices

To support the delivery of this key area, GP practices are encouraged to utilise the following key tools to implement a reduction in antimicrobial prescribing:

• Antibiotic prescribing review
• Antibiotic prescribing review - data collection form
• The ‘Treating your infection’ leaflet (EMIS web version here) (Vision version here) (System One version here) can be used as a tool to interact with patients and supports the evidence based information on the Self Care posters. Click here for instructions to import leaflet to EMIS Web. Click here for instructions to import leaflet to Vision. Click here for instructions to import leaflet to System One.
• The back-up prescription can reduce antibiotic prescribing by about 30 to 40%, and is extremely useful for particularly demanding patients or just before a weekend to reduce visits to out-of-hours services.
• Specific Read codes – when using the leaflet, practitioners ideally would use one of the following Read codes:
• EMIS web codes - 8BP0 (deferred antibiotic therapy), 8OA9 (provision of written info about antibiotic therapy), 8CAk (patient advised to delay filling of prescription), 8CE (self-help advice leaflet given).
• TPP codes – XaKYH (deferred antibiotic therapy), XaaJM (provision of written information about antibiotics).

These read codes will enable practices to audit their use of the leaflet and can be used to record ‘no’ or ‘back-up’ prescription decisions for appraisal and monitoring purposes.

Other resources

• TARGET Antibiotics Toolkit

TARGET stands for: Treat Antibiotics Responsibly, Guidance, Education, Tools

The TARGET Antibiotics Toolkit aims to help influence prescribers’ and patients’ personal attitudes, social norms and perceived barriers to optimal antibiotic prescribing. It includes a range of resources that can each be used to support prescribers’ and patients’ responsible antibiotic use, helping to fulfil CPD and revalidation requirements.