Public Health Agency

AMR & antimicrobial stewardship

Drugs that are active against microorganisms (antimicrobials) include antibiotics, antiprotozoals, antivirals and antifungals.  

The use and misuse of antimicrobial drugs has accelerated the emergence of resistant microorganisms. For example, antibiotics have been widely used since the 1940s, and this has led to an increase in antibiotic resistance over time.

Infections caused by resistant microorganisms often fail to respond to the standard treatment, resulting in prolonged illness, higher healthcare expenditures, and an increased mortality rate.

Antimicrobial resistance (AMR) refers to micro-organisms’ ability to change and become less susceptible to drugs, therefore surviving exposure to a drug that would normally kill them or inhibit their growth. AMR is a major issue and the clinical, public health and economic implications of antimicrobial resistance present a significant threat to future healthcare delivery. The World Health Organisation (WHO) rank the rapid development of antibiotic resistance as ‘one of the greatest threats to human health’.

To slow down the development of antibiotic resistance, it is important to use antibiotics in the right way. This means using the right drug, at the right dose, at the right time and for the right duration.   

Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by resistant microorganisms. 

The Strategy for Tackling Antimicrobial Resistance (STAR) 2012-2017 states that:

 ‘The overall goal of antimicrobial stewardship is to optimise clinical outcomes whilst minimising the unintended consequences of antimicrobial use. It is a multifaceted approach that includes policies, guidelines, education, monitoring and audit. It should not be seen as a separate issue to that of controlling healthcare associated infections, as both are required in healthcare institutions, therefore a whole-systems approach is required’.

This strategy lays out what an antimicrobial stewardship programme should include and how it should be applied in different healthcare settings i.e. Secondary care, primary care and hospital/community interface. The full strategy can be viewed here.

The National Institute for Health and Care Excellence (NICE) Quality Standard on Antimicrobial stewardship was published on the 22nd April 2016. This quality standard covers the effective use of antimicrobials to reduce the emergence of antimicrobial resistance. It covers all settings, all formulations of antimicrobials (oral, parenteral and topical agents) and is for health and social care practitioners, organisations that commission, provide or support the provision of care, as well as people using antimicrobials and their carers. This NICE Quality Standard can be viewed here.