Inside Health 24/10/17

English surveillance programme for antimicrobial utilisation and resistance ESPAUR 4th report October 2017
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/653443/ESPAUR_report_2017_.pdf

https://academic.oup.com/jac/article-abstract/doi/10.1093/jac/dkx323/4161408/Trends-and-patterns-in-antibiotic-prescribing

resistance systematic review bmj 2010
http://www.bmj.com/content/340/bmj.c2096

Individuals prescribed an antibiotic in primary care for a respiratory or urinary infection develop bacterial resistance to that antibiotic. The effect is greatest in the month immediately after treatment but may persist for up to 12 months. This effect not only increases the population carriage of organisms resistant to first line antibiotics, but also creates the conditions for increased use of second line antibiotics in the community.
2016 – O Neill review – to “We will reduce inappropriate antibiotic prescribing by 50%, with the aim of being a world leader in reducing prescribing by 2020”
but what is inappropriate ?
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/553471/Gov_response_AMR_Review.pdf
https://www.england.nhs.uk/wp-content/uploads/2016/09/annx-b-quality-premium-14-07-17.pdf

interventions to help

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003543.pub4/abstract

http://www.sciencedirect.com/science/article/pii/S1473309916000657

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00215-4/fulltext

http://www.ggcmedicines.org.uk/media/uploads/ps_primary_care/mupc__april_2017.pdf
prescription pads – jeez
https://www.campaignlive.co.uk/article/public-health-englands-catchy-jingle-aims-danger-antibiotic-resistance-unforgettable/1447966
Scotland mirrors England
lower use in primary care – since 2012 9.5% drop in abs use and dentists
but increased in hospital http://www.isdscotland.org/Health-Topics/Prescribing-and-Medicines/Publications/2016-08-30/2016-08-30-SAPG-2015-Report.pdf
rise in nurse prescriptions
https://academic.oup.com/jac/article/70/12/3384/2363736/Growth-in-nurse-prescribing-of-antibiotics-the

factors influencing prescribing GP
popularity scores – feedback – lower prescribers less popular
http://bjgp.org/content/early/2015/12/04/bjgp15X688105

lack of feedback http://bmjopen.bmj.com/content/bmjopen/6/11/e011882.full.pdf
deprivation-> increased association with prescribing abs
http://www.isdscotland.org/Health-Topics/Prescribing-and-Medicines/Publications/2016-08-30/2016-08-30-SAPG-2015-Report.pdf

clear guidelines in audit cycle
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411727/

jama – 2014 – more likely to over prescribe later in day – decision fatigue – later in day

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