Antimicrobial stewardship

221 Pages·2015·3.38 MB·English

by  Rebekah Robinson

NICE Medicines and prescribing

centre

DRAFT for consultation
Antimicrobial
stewardship
Antimicrobial stewardship: systems and
processes for effective antimicrobial
medicine use
Medicines practice guideline
Appendices
February 2015
Draft for consultation
National Institute for Health and Care
Excellence
Disclaimer
This guideline represents the views of NICE and was arrived at after careful consideration of
the evidence available. Those working in the NHS, local authorities, the wider public,
voluntary and community sectors and the private sector should take it into account when
carrying out their professional, managerial or voluntary duties.
Implementation of this guidance is the responsibility of local commissioners and/or providers.
Commissioners and providers are reminded that it is their responsibility to implement the
guidance, in their local context, in light of their duties to have due regard to the need to
eliminate unlawful discrimination, advance equality of opportunity and foster good relations.
Nothing in this guidance should be interpreted in a way that would be inconsistent with
compliance with those duties.
Copyright
National Institute for Health and Care Excellence 2015
Declarations of interest
Contents
Appendices .................................................................................................................................... 5
Appendix A: Declarations of interest ................................................................................... 5
A.1 Guideline development group (GDG) members .................................................. 5
A.2 NICE project team and additional GDG meeting attendees ............................. 17
Appendix B: Scope ............................................................................................................. 21
Appendix C: How this guideline was developed............................................................... 27
C.1 Search strategies for the guideline ..................................................................... 27
C.1.1 Scoping searches .................................................................................. 27
C.1.2 Main searches ........................................................................................ 29
C.1.3 Economic evaluations and quality of life data ..................................... 38
C.2 Review questions and review protocols ............................................................. 42
C.2.1 Reducing antimicrobial resistance........................................................ 42
C.2.2 Decision making ..................................................................................... 45
C.2.3 Barriers to decision making ................................................................... 49
C.2.4 Timely adoption and diffusion of a new antimicrobial ......................... 51
C.3 Clinical consort diagrams ..................................................................................... 54
C.3.1 Reducing antimicrobial resistance........................................................ 54
C.3.2 Decision making ..................................................................................... 55
C.3.3 Barriers to decision making ................................................................... 56
C.3.4 Timely adoption and diffusion of a new antimicrobial ......................... 56
C.4 Economic consort diagrams ................................................................................ 57
C.4.1 Reducing antimicrobial resistance........................................................ 57
C.4.2 Decision making ..................................................................................... 57
C.4.3 Barriers to decision making ................................................................... 57
C.4.4 Timely adoption and diffusion of a new antimicrobial ......................... 57
C.5 Clinical excluded studies...................................................................................... 58
C.5.1 Reducing antimicrobial resistance........................................................ 58
C.5.2 Decision making ..................................................................................... 76
C.5.3 Barriers to decision making ................................................................... 92
C.5.4 Timely adoption and diffusion of a new antimicrobial ......................... 99
C.6 Economic excluded studies ................................................................................. 99
C.6.1 Reducing antimicrobial resistance........................................................ 99
C.6.2 Decision making ..................................................................................... 99
C.6.3 Barriers to decision making ................................................................. 100
C.6.4 Timely adoption and diffusion of a new antimicrobial ....................... 100
Appendix D: Clinical evidence tables and GRADE profiles ........................................... 101
D.1 Evidence tables .................................................................................................. 101
D.1.1 Reducing antimicrobial resistance...................................................... 101

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Appendices

Declarations of interest
D.1.2 Additional evidence tables for reducing antimicrobial resistance
(de-escalation) ..................................................................................... 126
D.1.3 Decision making ................................................................................... 132
D.1.4 Barriers to decision making ................................................................. 170
D.1.5 Timely adoption and diffusion of a new antimicrobial ....................... 182
D.2 GRADE profiles and forest plots ....................................................................... 184
D.2.1 Reducing antimicrobial resistance...................................................... 184
D.2.2 Decision making ................................................................................... 205
D.2.3 Barriers to decision making ................................................................. 211
D.2.4 Timely adoption and diffusion of a new antimicrobial ....................... 212
Appendix E: Economic evidence tables .......................................................................... 214
E.1 Reducing antimicrobial resistance. ................................................................... 214
E.2 Decision making ................................................................................................. 214
E.3 Barriers to decision making ............................................................................... 215
E.4 Timely adoption and diffusion of a new antimicrobial ...................................... 215
Appendix F: Linking evidence to recommendations ...................................................... 216
Appendix G: Organisations providing written or oral evidence ..................................... 218
Appendix H: Quality assessment checklist ..................................................................... 220

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Appendices

Declarations of interest
Appendices
Appendix A: Declarations of interest
A.1 Guideline development group (GDG) members
Alastair Hay (Chair)
GDG meeting Declaration of interest Action taken
Recruitment None None
First GDG meeting (3 June Member of Advisory Committee on Antimicrobial Project lead will monitor for any potential conflict.
2014) Resistance and Healthcare Associated Infection.
Would like to be aware of evidence gaps and GDG Advice given regards ensuring that information learnt as
research recommendations that could influence future part of the NICE guideline process is not shared with other
research programme. committees/groups etc.
Second GDG meeting (8 Has an interest in the longitude prize, no financial None
September 2014) interests, no involvement in any new antimicrobials.
Third GDG meeting (30 No changes to record None
September 2014)
Fourth GDG meeting (14 No financial conflicts of interest to declare. Lead a group Advice given regards ensuring that information learnt as
November 2014) at the University of Bristol conducting research into part of the NICE guideline process is not shared with other
primary care infections and antimicrobial resistance. committees/groups etc.
Tessa Lewis (Vice-chair)
GDG meeting Declaration of interest Action taken
Recruitment None None
First GDG meeting (3 June No changes to record None
2014)
Second GDG meeting (8 No changes to record None
September 2014)

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Appendices

Declarations of interest
GDG meeting Declaration of interest Action taken
Third GDG meeting (30 No changes to record None
September 2014)
Fourth GDG meeting (14 No changes to record None
November 2014)
Chris Cefai
GDG meeting Declaration of interest Action taken
Recruitment None None
First GDG meeting (3 June No changes to record None
2014)
Second GDG meeting (8 No changes to record None
September 2014)
Third GDG meeting (30 No changes to record None
September 2014)
Fourth GDG meeting (14 No changes to record None
November 2014)
Esmita Charani (until 27 November 2014)
GDG meeting Declaration of interest Action taken
Recruitment None None
First GDG meeting (3 June Published in peer reviewed journals. Advice given regards ensuring that information learnt as
2014). part of the NICE guideline process is not shared with other
committees/groups or included within any written articles.

Reminded that opinions expressed that may be relevant to
the guideline may lead to a conflict of interest.
Emailed 31 July 2014 Published author on research into antimicrobial Chair and Project lead will monitor for any potential conflict.
stewardship interventions and behaviour change in this Also discussed with the Nice Medicines and prescribing
field including Cochrane reviews (one ongoing at centre Programme Director.
present). Has also published research on use of mobile Advice given regards ensuring that information learnt as
health technology to deliver antimicrobial stewardship part of the NICE guideline process is not shared with other
committees/groups or included within any written articles.

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Appendices

Declarations of interest
GDG meeting Declaration of interest Action taken
interventions.
Salary is funded by the National Institute of Health
Research on a grant investigating behaviour change in
antimicrobial prescribing.
Honorary visiting researcher to Haukeland University in
Norway where advice on the implementation of the
national implementation of an antimicrobial stewardship
programme.
Second GDG meeting (8 No changes to record None
September 2014)
Third GDG meeting (30 No changes to record None
September 2014)
Fourth GDG meeting (14 Undertaking research at PhD level into antibiotic Chair and Project lead will monitor for any potential conflict.
November 2014) prescribing behaviours in secondary care. Advice given regards ensuring that information learnt as
part of the NICE guideline process is not shared with other
Published author in the field of antibiotic prescribing
committees/groups or included within any written articles.
behaviours and antimicrobial stewardship.

Lynne Craven
GDG meeting Declaration of interest Action taken
Recruitment None None
First GDG meeting (3 June No changes to record None
2014)
Second GDG meeting (8 No changes to record None
September 2014)
Third GDG meeting (30 No changes to record None
September 2014)
Fourth GDG meeting (14 No changes to record None
November 2014)

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Appendices

Declarations of interest
Martin Duerden
GDG meeting Declaration of interest Action taken
Recruitment Received personal payment (honoraria) plus Advice given regards ensuring that information learnt as
reimbursement of expenses from Reckitt Benckiser (RB) part of the NICE guideline process is not shared with other
to speak at 2 meetings in the last 12 months. The subject committees/groups or included within any written articles.
of the talks was antibiotic use in respiratory infections at
each meeting but there was no promotion of products
Advised not to write for any publication until the guideline
marketed by RB in the content.
has published.
In the last 12 months has also received payment from the
publishers of Pulse, GP and Prescriber for writing various
articles on prescribing and therapeutics, including
antibiotic use.
First GDG meeting (3 June Clinical Adviser on Prescribing for the Royal College of None
2014) General Practitioners but does not receive payment for
this.
Emailed 26 August 2014 Member of the Global Respiratory Infection Partnership Advice given regards ensuring that information learnt as
(work declared above with RB done in this capacity). Now part of the NICE guideline process is not shared with other
spoken at 4 meetings in the last 12 months. committees/groups or included within any written articles.

On the Editorial Board of Drug and Therapeutics Bulletin,
a BMJ Group publication, this is a paid position. Advised not to write for any publication until the guideline
has published.
On the editorial board of Prescriber (a Wiley publication)
which is an unpaid position. Occasionally writes opinion
based editorials and articles for this publication. Receives
payments for these.
In the last year was commissioned and co-wrote a report
on Polypharmacy for the King’s Fund and received
payment for this. Also spoke at a King’s Fund seminar on
the topic.
I am a member of the Paediatric Formulary Committee for
the British National Formulary (BNF) payment not
received for this.
Second GDG meeting (8 No changes to record None
September 2014)
Third GDG meeting (30 No changes to record None

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Appendices

Declarations of interest
GDG meeting Declaration of interest Action taken
September 2014)
Fourth GDG meeting (14 Recently has received small payments for articles on the Advice given regards ensuring that information learnt as
November 2014) Lipid Modification Clinical Guideline from Pulse and from part of the NICE guideline process is not shared with other
Guidelines in Practice. committees/groups or included within any written articles.
Chair and Project lead will monitor for any potential conflict.
Member of the NICE Guideline Development Group on
Lipid modification: cardiovascular risk assessment and
the modification of blood lipids for the primary and
secondary prevention of cardiovascular disease.
On the Medicines Committee for the Royal College of
Paediatrics and Child Health - payment not received for
this.
Member of the NICE technology appraisals Committee
until October 2014. This is not a paid position.
Fifth GDG meeting (16 March
2015)
Heather Edmonds
GDG meeting Declaration of interest Action taken
Recruitment None None
First GDG meeting (3 June No changes to record None
2014)
Second GDG meeting (8 No changes to record None
September 2014)
Third GDG meeting (30 No changes to record None
September 2014)
Fourth GDG meeting (14 No changes to record None
November 2014)
Rose Gallagher
GDG meeting Declaration of interest Action taken
Recruitment None None

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Appendices

Declarations of interest
GDG meeting Declaration of interest Action taken
Second GDG meeting (8 Involved in a Royal College of Nursing published position Chair and Project lead will monitor for any potential conflict
September 2014) statement which was sponsored by Pfizer.
Advice given regards ensuring that information learnt as
part of the NICE guideline process is not shared with other
committees/groups etc.
Third GDG meeting (30 No changes to record None
September 2014)
Fourth GDG meeting (14 No changes to record None
November 2014)
Philip Howard
GDG meeting Declaration of interest Action taken
Recruitment Paid consultancy work on antibiotics for the Advised not to undertake any further consultancy work in
pharmaceutical industry i.e. Pfizer (Linezolid), Astellas this area during the development of the guideline through to
(Levofloxacin), AstraZeneca (Ceftaroline), Novartis publication.
(Daptomycin), Gilead (Ambisome).
First GDG meeting (3 June Paid consultancy work with Danone on antimicrobial Advised not to undertake any further consultancy work in
2014) stewardship. this area during the development of the guideline through to
publication.
Committee member of UK Clinical Pharmacy Association

- Pharmacy Infection Network.
Advice given regards ensuring that information learnt as
Council member of British Infection Association (until May
part of the NICE guideline process is not shared with other
2013).
committees/groups etc.
Council member of British Society of Antimicrobial
Chemotherapy. Chair and Project lead will monitor for any potential conflict
Represented International Pharmaceutical Federation
(FIP) at WHO (World Health Organisation) Antimicrobial
Resistance Strategic Technical Advisory Group (May
2014).
Published unpaid articles related to AMS.
Spokesman on Antimicrobials for Royal Pharmaceutical
Society.

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