Clinicians are being encouraged during Antibiotic Awareness Week to consider ‘Choosing Wisely’ recommendations on antibiotic use before prescribing unnecessarily.
World Antibiotic Awareness Week 2017 (November 13 to 19) is a World Health Organization global event around one of the most pressing challenges to health care – including the risk of relatively common infections developing resistance to the antibiotics usually used to treat them.
Late last year New Zealand’s Council of Medical Colleges facilitated the local launch of the global Choosing Wisely initiative in partnership with the Health Quality and Safety Commission and Consumer. The initiative – targeted at both health professionals and consumers – aims to avoid unnecessary clinical interventions including inappropriate prescribing of antibiotics.
Dr John Bonning, from the Council’s executive, said a growing number of infections, such as pneumonia, tuberculosis, and gonorrhoea, are becoming harder to treat as the antibiotics used to treat them become less effective. He said as part of the Choosing Wisely campaign the Council worked with Australasian and New Zealand Colleges and specialist societies to develop specific recommendations about antibiotic use.
“These recommendations include situations when antibiotics should not routinely be used – such as for upper respiratory tract infections, the use of topical antibiotics on surgical wounds, and for the treatment of fever in children without a bacterial infection.” (See list of recommendations and links below.)
The Ministry of Health’s Director of Public Health, Dr Caroline McElnay, says New Zealand this year presented its Antimicrobial Resistance Action Plan as part of the commitment to tackling the global challenge.
Michael Baker, spokesperson for the College of Public Health Medicine said it was essential that New Zealand implemented the plan and echoed that antibiotic resistance was a global issue in which New Zealand “absolutely has to play its part”. “We need widespread commitment and leadership from medical, veterinary and agricultural sectors in New Zealand, working together.”
Hilary Graham-Smith of the New Zealand Nurses Organisation said nurses are in the frontline of helping patients around proper use of antibiotics. “Nurses have an integral part to play. Some nurses are prescribers now and more will come. Education about the importance of taking antibiotics as recommended by a health professional, not sharing them, and reporting adverse effects, is key to managing the use of antibiotics well.”
Wellington GP Dr Cathy Stephenson said it’s crucial to work out whether or not a person really needs an antibiotic.
“It’s partly about explaining to patients why antibiotics won’t help. But it’s also about giving them some practical advice that will help them, or their child, feel better – getting good rest, ensuring adequate fluid intake, and advising on proper pain relief. Often when you explain all this, people are actually very happy to avoid antibiotic use.”
Dr John Wyeth from Pharmac says they are charged with getting the best possible health outcomes for New Zealanders from the public medicines budget – and antimicrobial resistance could undermine that.
“We often forget that things we take for granted, like chemotherapy and surgery, would not be possible without antibiotics.”
Choosing Wisely antibiotic use recommendations
- Do not use antibiotics in asymptomatic bacteriuria.http://choosingwisely.org.nz/professional-resource/asid/#1
- Do not take a swab or use antibiotics for the management of a leg ulcer without clinical infection.http://choosingwisely.org.nz/professional-resource/asid/#2
- Avoid prescribing antibiotics for upper respiratory tract infection.http://choosingwisely.org.nz/professional-resource/asid/#3
- Do not use antimicrobials to treat bacteriuria in older adults where specific urinary tract symptoms are not present.http://choosingwisely.org.nz/professional-resource/anzsgm/#3
- Don’t use oral antibiotics for the treatment of atopic dermatitis unless there is clinical evidence of infection.http://choosingwisely.org.nz/professional-resource/nzds/#4
- Don’t routinely use topical antibiotics on a surgical wound.http://choosingwisely.org.nz/professional-resource/nzds/#5
- Do not routinely prescribe oral antibiotics to children with fever without an identified bacterial infection.http://choosingwisely.org.nz/professional-resource/pchd/#1
- Consider antibiotic de-escalation daily for intensive care patientshttp://choosingwisely.org.nz/professional-resource/anzics/#5
Choosing Wisely also encourages health professionals to share the campaign’s resources for consumers including:
- Antibiotics for sinusitis
- Antibiotics for your skin
- Coughs, colds & sore throats – manage symptoms without antibiotics
- Ear infection – treatments
‘WISE’ questions to help avoid unnecessary prescribing/interventions
- Why? What will this test, treatment or procedure change?
- Is there an alternative? Less invasive, less resource intensive?
- Seek clarification. Clarify why the doctor ordered this test
- Explore/explain. Be the patient’s advocate. Explore concerns, take time to explain why a test, treatment or procedure is/isn’t necessary
Source: From resources developed by the New Zealand Medical Students Association to support the Choosing Wisely campaign: choosingwisely.org.nz/professional-resource/nzmsa/