NIHR Signal Adding the extra antibiotic rifampicin did not improve cure rates after sepsis

NIHR Signal Adding the extra antibiotic rifampicin did not improve cure rates after sepsis
Published on 17 April 2018


Adding the antibiotic rifampicin did not improve cure rates or reduce deaths for people with bacterial blood infections caused by Staphylococcus aureus.
https://discover.dc.nihr.ac.uk/content/signal-00584/adding-the-extra-antibiotic-rifampicin-did-not-improve-cure-rates-after-sepsis


From the NIHR Dessemination Centre

NIHR Signal Intravenous antibiotics, administered over 3 hours, are linked to lower death rates in sepsis

The risk of death in adults with sepsis was 30% lower when each dose of antibiotic was given intravenously over three hours compared to a bolus or less than 60 minutes.


This systematic review included adults on intensive care units with a range of ages, severity of sepsis and other symptoms. A variety of antibiotics of the anti-pseudomonal beta-lactam class were used in the trials. These included carbapenems, penicillins and cephalosporins.


From the Dissemination Centre

Sore throat (acute): antimicrobial prescribing [NG 84]

New:  NICE guideline


acute sore throat (including pharyngitis and tonsillitis) is self‑limiting and often triggered by a viral infection of the upper respiratory tract

symptoms can last for around 1 week, but most people will get better within this time without antibiotics, regardless of cause (bacteria or virus).

Assess and manage children under 5 who present with fever as outlined in the NICE guideline on fever in under 5s.

Use FeverPAIN or Centor criteria to identify people who are more likely to benefit from an antibiotic and manage in line with recommendations 1.1.4 to 1.1.13.

NIHR Signal Blood test reduces mortality and shortens antibiotic use among adults with chest infection

It may be feasible to use procalcitonin blood levels to guide antibiotic treatment for adults in hospital with a suspected chest infection. By measuring procalcitonin, an indicator of bacterial infection, clinicians could review their diagnosis earlier.


This reduced antibiotic exposure by 2.5 days with fewer adverse effects and also less mortality. About 14 extra people in every 1,000 who had their management guided by the blood test would be expected to survive the first month, compared with those receiving standard care without this test.


From the NIHR Dissemination Centre

NIHR Signal A strategy of 'delayed antibiotic prescribing' for respiratory infections may reduce antibiotic use

Delaying antibiotic prescribing made little difference to most symptoms of respiratory infection. It reduced antibiotic use and did not affect patient satisfaction compared with immediate prescribing of antibiotics.

Increasing antibiotic resistance is a global health concern. Many people don’t realise that viruses cause most respiratory infections and that antibiotics won’t help. The strategy allows some time for symptoms to improve naturally.

From the NIHR Dissemination Centre

NIHR Signal Computerised decision support can improve antibiotic prescribing in hospitals

Using a computerised decision support tool (software used by hospital prescribers) improved the adequacy of antibiotic coverage and adherence to guidelines, and may have reduced the risk of people dying. Only four studies reported on resistance to antibiotics, so no conclusions can be drawn about the impact of this tool on resistance.

Antibiotic stewardship programmes aim to get prescribers to think before they decide to prescribe antibiotics, then consider the type and dose of antibiotic. Computerised decision support aims to support this practice by embedding these principles into everyday practice.

From the NIHR Dissemination Centre

Use antibiotics effectively to reduce drug-resistance

Research, published in the Lancet, has found antibiotic stewardship programmes can reduce the number of hospital infections caused by multidrug-resistant bacteria by 51%. It also shows the number of people experiencing drug-resistant infections decreases further when infection control measures, such as good hand hygiene, are followed.

NIHR Signal Long-term antibiotics likely to reduce risk of recurrent cellulitis

Antibiotics may reduce the risk of leg cellulitis by about two thirds, in adults who have had at least two previous episodes, but only while they take the antibiotics. There is limited evidence measuring the efficacy of other forms of prevention
.
A review of five studies showed that the risk of developing repeated cellulitis was reduced in participants who were taking long-term (more than six months) penicillin or erythromycin, compared with a control group. Once the antibiotic course had finished, participants’ risk of recurrent cellulitis was no different from the control group.


Cellulitis is a bacterial skin infection that spreads and worsens quickly. Risk of recurrence is high in people with a predisposing condition such as poor leg circulation.


This review explored the effectiveness of various preventative interventions for recurrent cellulitis. It highlights the need to explore non-pharmacological options, such as compression stockings, moisturisers or exercise. These could be cheaper and avoid the risk of increasing antibiotic resistance, but few studies of these options were identified.


From the NIHR Dissemination Centre

NIHR Signal Carefully managed antibiotic use could halve antibiotic-resistant infections

Antibiotic stewardship programmes could halve the number of infections due to antibiotic-resistant bacteria compared with unguided prescribing. Combining these programmes with hand hygiene, such as washing hands with soap and water and using alcohol-based hand-rubs, could reduce antibiotic resistance further.

Bacterial resistance to existing antibiotics is increasing, and for some conditions, there aren’t enough new antibiotics available to treat infections caused by resistant bacteria.

Antibiotic stewardship involves promoting the appropriate use of antibiotics according to local resistance patterns and aims to give patients the right antibiotics for the right length of time and at the correct dose, reducing the unnecessary use of antibiotics.

Limitations of this review were that only 32 studies, half of all the studies found, could be combined in the analysis and some of the studies were over 20 years old. Nevertheless, it highlights that antibiotic stewardship is effective and needs to be implemented across all care settings.

From the NIHR Dissemination Centre

Enhancing antibiotic stewardship by tackling “spurious” penicillin allergy

Clin Exp Allergy. 2017;47:1362–1373. https://doi.org/10.1111/cea.13044

Approximately 90-99% of patients with a label of penicillin allergy (PenA) are not allergic when comprehensively investigated. An inaccurate label of PenA has major public health implications—longer hospital stay, more frequent hospital admissions, greater use of fluoroquinolones, glycopeptides, cephalosporins and other expensive antibiotics resulting in significantly higher costs to the health service and predisposing to Clostridium difficile, methicillin-resistant Staphylococcus aureus infections and vancomycin-resistant enterococcus. We describe lessons learnt from recent studies regarding possible reasons contributing to an inaccurate label of PenA as well as propose a concerted multidisciplinary approach to address this important public health problem. Given the unmet need for allergy services in the UK and several other countries and knowledge gaps regarding PenA amongst healthcare professionals, we describe the potential role for a computerized clinical decision support system to enable non-specialists rapidly identify and de-label “low-risk” hospitalized patients with a label of PenA thereby obviating the need for allergy tests. This approach however needs rigorous evaluation for feasibility, safety, patient and physician acceptability, cost-effectiveness and its compatibility with information technology systems currently employed in the health service.

UHCW Research: M. Li

NICE Bites: February 2017

NICE Bites is a monthly bulletin from the North west Medicines Information Centre which summarises key prescribing points from NICE guidance.

February's bulletin covers antimicrobial stewardship

Updated Cochrane review on antimicrobial stewardship focuses on behaviour change interventions

Effective and sustained improvement in antibiotic prescribing requires quality improvement approaches using behaviour change techniques and methodologies, with AMS focusing on a specific target audience using specific behavioural intervention functions.

An updated Cochrane review has demonstrated that “enabling” and “restrictive” interventions were associated with a 15% increase in compliance with desired practice, an almost two-day decrease in duration of antibiotic treatment and a more than one-day decrease in inpatient length of stay – without compromising patient safety [2]. The authors suggest that further improvement could be achieved with additional behaviour change intervention functions, particularly explicit goal setting and action planning.