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06 Oct 2015 Publication of the 'Report on Antimicrobial Use and Resistance in Humans in 2014'

Encouraging signs but the work continues

A new report published today by Health Protection Scotland and Information Services Division on behalf of the Scottish Antimicrobial Prescribing Group (SAPG) shows that work by SAPG continues to pay off with another drop in the use of antibacterials recorded. However, the report also notes that further work needs to be done to continue the downward pressure on unnecessary prescribing.

In 2014 the use of systemic antibacterials in primary care (excluding dental) was 1.9% lower than in 2013 – a return to the prescribing levels seen in 2005.

The total use of systemic antibacterials in hospitals showed a 5.9% increase from 2013, continuing the upward trend seen in this area since 2009.

There was a 2.1% increase in Scottish hospitals in the use of carbapenems, which may be regarded as the drugs of last resort used to treat infections caused by Gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae. This is a particular and growing public health concern as there are limited treatment options for infections caused by these bacteria once they become resistant to carbapenems.

Professor Dilip Nathwani, Chair of SAPG said: “I am pleased to note prescribing of antibiotics in primary care has reduced for the second year running and has returned to the same level as in 2005. I am grateful to healthcare professionals and the public for their support in improving the use of this vital group of medicines. However use of antibiotics in hospital has increased and so there is still further work to be done in reducing inappropriate use of this vital group of medicines to keep resistance rates as low as possible and to tackle Clostridium difficile infections. SAPG will continue to work closely with prescribers, health and care staff, patients and the public to improve antibiotic use across all care settings across Scotland”.

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Notes to editors

The “Report on Antimicrobial Use and Resistance in Humans in 2014” is available at:

https://isdscotland.scot.nhs.uk/Health-Topics/Prescribing-and-Medicines/Publications/

The report is intended to support NHS boards, hospitals and primary care in their long term planning of antimicrobial prescribing. In particular, this report should be of use to antimicrobial management teams (AMTs), infection prevention and control teams (ICTs) and microbiologists.

SAPG guidance on prescribing is available at:

http://www.scottishmedicines.org.uk/smc/6627.221.286.html

SAPG is a national clinical multi-disciplinary forum formed in March 2008 by the Scottish Government Health Department (SGHD) with representation from key stakeholders including all mainland health boards. The forum is hosted by the Scottish Medicines Consortium and SAPG’s primary objectives are to co-ordinate and deliver a national framework for antimicrobial stewardship to enhance the quality of antimicrobial prescribing and infection management in Scotland. This will primarily be achieved through improved systems and processes for collation, analysis, correlation and reporting of antimicrobial utilisation and resistance data and improved education programmes for healthcare professionals. This supports work undertaken by antimicrobial management teams and infection prevention and control teams within NHS boards to improve antimicrobial prescribing and contain the spread of antimicrobial resistance.

Health Protection Scotland (HPS) and Information Services Division (ISD) are part of NHS National Services Scotland (NSS), a special health board providing services critical to frontline patient care and supportive of the efficient and effective operation of NHS Scotland.

What are antibiotics, antimicrobials and antibacterials, and what are they used for?
Antimicrobials and antibacterials are both terms used to describe antibiotics, a group of drugs used to treat and prevent bacterial infections. Used appropriately, antibiotics are valuable and effective treatments and can combat bacteria which cause infections. When antibiotics are used inappropriately, bacteria can develop resistance to the antibiotic, meaning that the bacteria are not killed and infection can occur or continue. Use of the wrong antibiotic or combination of antibiotics can also affect the natural balance of the body, giving rise to opportunistic infections such as Clostridium difficile.

Why is antimicrobial resistance a problem?
Antimicrobial resistance continues to pose a serious public health threat globally. The loss of effective antimicrobials challenges our capability to fight infectious diseases and prevent and manage the infectious complications common in vulnerable patients undergoing chemotherapy for cancer, dialysis, and surgery, especially organ transplantation, for which the ability to treat secondary infections is crucial.

The development of bacterial resistance is a complex evolutionary process. It is accepted that the main driver for the development of resistance is exposure to antimicrobials and that resistance is greatest where use is greatest. Although antimicrobial resistance cannot be eradicated, joint efforts by healthcare professionals and the public to ensure antibiotics are only used when necessary (and in appropriate doses and durations) can help limit the threat and minimise the impact on health.

The problem is further exacerbated by the fact that a new infectious disease has been discovered almost every year over the past 30 years, while very few new antimicrobials have been developed. It is therefore essential to preserve the effectiveness of the currently available antimicrobials.

What would constitute inappropriate use and why is widespread inappropriate use a problem?
Inappropriate use might involve prescription of antibiotics unsuitable for the infection, or it may be that a patient does not finish their course of antibiotics, meaning that the bacteria are not all killed and can become resistant to the antibiotic which had been used. Where resistant strains develop and pass between people to become widespread, this lessens the treatment options available and can increase the burden of infection in the community.