Antimicrobrial stewardship

Question 1

What is Antimicrobial Stewardship (AMS) according to NICE and BSAC?

Answer 1

NICE (NG15, 2015): An organizational approach to promote and monitor the judicious use of antimicrobials to preserve future effectiveness.
BSAC: Optimal selection, dosage, and duration of antimicrobial treatment for best clinical outcome with minimal toxicity and resistance impact.

Question 2

What are the four core goals of an AMS programme?

Answer 2

1. Improve patient outcomes (e.g. fewer surgical site infections)
2. Improve patient safety (reduce C. difficile, ADRs)
3. Reduce antimicrobial resistance (AMR)
4. Reduce healthcare costs

Question 3

Define Antimicrobial Resistance (AMR).

Answer 3

AMR is the loss of effectiveness of anti-infective agents (antivirals, antifungals, antibacterials, antiparasitics), often due to inappropriate broad-spectrum antimicrobial use.

Question 4

Why is AMR a growing concern?

Answer 4

Because of rising resistance over the past 40–50 years, compounded by the limited development of new antimicrobials.

Question 5

What is the Start Smart then Focus (SSTF) toolkit?

Answer 5

An evidence-based AMS framework for secondary care (esp. inpatient settings), updated in Sept 2023, aiming to reduce AMR risk and maintain quality care.

Question 6

What are the two components of Start Smart then Focus?

Answer 6

Start Smart: Only use antimicrobials when necessary; follow empiric guidelines and obtain MC&S.
Then Focus: Review treatment at 48–72 hrs based on MC&S; ensure clear indications and ongoing plans.

Question 7

What are the possible outcomes at the 48–72 hour antimicrobial review?

Answer 7

1. Stop if no evidence of infection
2. Switch IV to oral for discharge
3. Amend spectrum (narrow/broader)
4. Extend and document review date
5. Refer to non-ward antimicrobial services if needed

Question 8

What is the difference between a Soft Stop and a Hard Stop in antibiotic prescribing?

Answer 8

Soft Stop: Prompts prescribers to review antibiotics manually.
Hard Stop: Automatically discontinues antibiotics after set duration; clinician must review to continue.

Question 9

What is the TARGET Antibiotics Toolkit?

Answer 9

A toolkit developed by UKHSA, RCGP, and ASPIC for primary care to support AMS and responsible prescribing.
TARGET = Treat Antibiotics Responsibly, Guidance, Education, Tools.

Question 10

What roles do hospital pharmacists play in AMS?

Answer 10

Lead AMS programmes
Participate in ward rounds and review antimicrobials
Patient counseling
Audit and quality improvement
Ensure safety and efficacy of prescriptions

Question 11

What roles do community pharmacists play in AMS?

Answer 11

Screen prescriptions
Deliver NHS services
Educate on infection prevention and self-care
Perform diagnostic tests
Manage infections under PGD

Question 12

What roles do GP pharmacists have in AMS?

Answer 12

Diagnose and treat infections
Advise on evidence-based practices
Contribute to local formularies
Conduct clinical audits

Question 13

What is the role of pharmacists in academia and industry in AMS?

Answer 13

Research and discover new antimicrobials
Educate pharmacy students
Publish guidelines and scientific studies

Question 14

How should pharmacists apply AMS knowledge in practice?

Answer 14

Critically review prescriptions
Consider indication, dosage, interactions
Assess antibiotic appropriateness using local formularies and patient history

Question 15

Why is AMS essential for pharmacists to understand and implement?

Answer 15

Because AMR is a global threat, and pharmacists are key players in promoting safe, effective, and sustainable antimicrobial use.