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Managing common infections: guidance for primary care

New Public Health England guidelines address the worrying rise in drug-resistant bacteria

Emma Vincent
Posted 18 July 2016 - 13:52

Clostridium difficile bacteria and spores

Essential facts

An emergence worldwide of resistant bacteria is considered a major public health threat that is limiting or negating effective treatment of an ever-increasing range of infections. The overuse and inappropriate prescribing of antibiotics have contributed to this growth. Resistance to drugs that are antiviral, antifungal and antiparasitic is also being witnessed, therefore ‘antimicrobial resistance’ refers to the wider spectrum of drugs and is predicted to place substantial burden on health and NHS resources.

Clostridium difficile bacteria and spores. *Photo: SPL*

What’s new?

Public Health England (PHE) has published guidelines for managing common infections, including upper respiratory, lower respiratory and urinary tract infections. The guidelines are intended to provide a simple, effective, economical approach to common infections while encouraging the appropriate use and prescriptions of antibiotics in primary care. The guidelines are written for all primary care prescribers in general practice and out of hours settings – including nurses – and are supported by clinical evidence and expert practice. PHE encourages minor adaptations that reflect local infections and antimicrobial resistance – which, it says, could enhance the use of local expertise and networking to reduce further resistance.

PHE has included summary tables for the common infections in primary care that easily reference illness alongside treatment, choice of drug, adult/child dose and the duration of treatment. The guidelines can be used as a clinical aid and teaching tool, but PHE says that they should always be used alongside expert clinical judgement.

Why are the guidelines important?

The timeline for bacterial resistance is unpredictable. The guidelines discourage over use, aid appropriate prescribing and allow for the partial regulation of antibiotics. This is important because there are few new antibiotics available, which may be because research in this area has been scaled back. The World Health Organization (WHO) has suggested that this crisis in funding is due to the development not being considered a wise investment by the general pharmaceutical companies because antibiotics are only used for short periods of time.

How can you aid the implementation of these guidelines?

Foremost for any health professional is educating patients, carers and families. Patients need to understand when the use of antibiotics is appropriate. In particular, patients who have access to ‘rescue medication’ in chronic disease pathways need to be empowered in self-management programmes. Healthcare practitioners should ensure patient and carer understanding of the disease itself.

Professionally, healthcare practitioners are accountable for their prescribing competencies and auditing the use of antibiotics. PHE advocates clinical networks, local champions and collaboration that allows for reflection, shared success and innovation.

Nurse comment

The guidelines highlight the significance of bacterial resistance, even in everyday common infections. They support clinical expertise by encouraging:

Prescribing only when there is clear clinical benefit.
The use of simple generic antibiotics where possible.
Prescribing as soon as possible in severe infections.

As nurses we can lead the implementation of good practice by not prescribing over the telephone, and by avoiding broad spectrum prescription (such as co-amoxiclav) where possible to reduce the further risks of clostridium difficile and community-acquired MRSA.

WHO estimates drug-resistance bacteria is responsible for 5,000 deaths a year in the UK and 25,000 a year in Europe. As nurses we need to co-ordinate efforts to share knowledge, aspire new data collaborations and prevent the risk of further antibiotic crisis.

Emma Vincent

Interstitial lung disease nurse

Glenfield Hospital, Leicester

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