MRSA Action UK supported the development of the guideline on the prevention and control of healthcare associated infections, and welcomed the introduction of the quality statement on the requirement of judicious antimicrobial prescribing.
We are constantly contacted by patients and carers who are battling to fight infections that do not respond to antibiotics and the latest figures from Public Health England suggest there is more to worry about with the first rise in 3 years for cases of MRSA bloodstream infections.
As people who have been directly affected we welcome the opportunity to be stakeholders with NICE in developing the draft guidance. We would emphasise however, that the prescribing of antibiotics is, and will always be, the responsibility of the prescribing practitioner, whether that is in or outside of hospital. The guideline must be viewed as a minimum requirement, and colleagues should be encouraged to focus on judicious prescribing.
MRSA Action UK does not however support or agree with Professor Mark Baker’s comment in today’s media that NICE is considering bringing antibiotics into the existing bonus scheme for GP’s not to prescribe these drugs, this is both wrong and immoral as some patients will always require treatment for infections, it is the clinical need that needs to be ascertained and the correct diagnosis determined and appropriate treatment given that needs to be correct.
Making a decision about whether a respiratory illness is bacterial or viral is not always easy in someone who is more vulnerable. For example, some throat and ear infections are due to bacteria, and not viruses, and some people with a cough and breathlessness are actually developing pneumonia, which may be bacterial and antibiotics would be essential.
While tests such as throat swabs or sputum (mucus) samples can help with diagnosis, such investigations take time, so skill needs to be deployed to make these decisions. We would have to say that giving bonuses is not necessarily a prerequisite to a GP or any prescribers' ability to be able to do this. So financial incentives should not be the focus here, patient outcomes must always be the main focus of any prescriber; the need is for training and better information in this field of medicine.
Any respiratory illness that has continued for more than 14 days should be checked, as this may be the result of bacterial sinusitis, bronchitis, or even pneumonia.
Sometimes bacterial complications can follow what began as a viral infection. But giving a course of broad spectrum antibiotics at the start "just in case" is wrong, for what may happen is that a bacterial infection might mix with organisms that are resistant to the antibiotic, complicating the illness still further, possibly endangering life, and adding to the burgeoning problem of antimicrobial resistance.
Information for patients and the public will help enforce the step change needed in antimicrobial prescribing, particularly for conditions like coughs and colds that may get better without such intervention in the large majority of cases.
It cannot be emphasised enough, that there is a burgeoning problem with infections that will not respond to antibiotics, multi-drug resistant pathogens are on the increase and we are already seeing patients with wounds that are not responding to our precious arsenal of antimicrobials.
Some members of our charity have lost more than one person to MRSA and other infections that are difficult to treat; we want to see good infection prevention and control in our healthcare facilities.
Whilst responsibility for prescribing is with the healthcare practitioner we can all play our part. Good hand hygiene and seeking out information from our GPs on conditions that affect us and how to prevent their spread is a start. We do need to ask what our symptoms mean and understand them, as it is important that something that does need antimicrobial treatment is given promptly, so we shouldn’t be discouraged from asking our GP the questions about our condition, but the public has to recognise that a prescription for antibiotics is not a panacea for treating many of the conditions that we present with.
We look forward to working with NICE on the guideline and hope they take on board the need for more skills for GPs and prescribers rather than cash incentives.
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