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Antimicrobial resistance (AMR) continues to be a global problem and continues to be addressed through national strategies to improve diagnostics, develop new antimicrobials and promote antimicrobial stewardship. Patients who attend general (ambulatory) practice with symptoms of respiratory tract infections (RTIs) are invariably assessed by some sort of clinical decision rule (CDR). However, CDRs rely on a cluster of non-specific clinical observations. A narrative review of the literature was undertaken to ascertain the value of C reactive protein (CRP) point-of-care testing (POCT) to guide antibacterial prescribing in adult patients presenting to general practitioner (GP) practices with symptoms of RTI. Studies that were included were Cochrane reviews, systematic reviews, randomised controlled trials, cluster randomised trials, controlled before and after studies, cohort studies and economic evaluations. An overwhelming number of studies demonstrated that the use of CRP tests in patients presenting with RTI symptoms reduces index antibacterial prescribing. GPs and patients report a good acceptability for a CRP POCT and economic evaluations show cost-effectiveness of CRP POCT over existing RTI management in primary care. POCTs increase diagnostic precision for GPs in the better management of patients with RTI. With the rapid development of artificial intelligence, patients will expect greater precision in diagnosing and managing their illnesses. Adopting systems that markedly reduce antibiotic consumption is a no-brainer for governments that are struggling to address the rise in AMR.

Aim: To estimate the costs and benefits for a UK hospital pharmacy of stocking a single low molecular weight heparin (LMWH), enoxaparin, compared to stocking unfractionated heparin (UFH) and stocking both UFH and multiple different LMWHs.Methods: A decision-tree model was developed which considered the use of heparins for five indications: prophylaxis against venous thromboembolism (VTE) in major orthopaedic surgery; VTE prophylaxis in major general surgery; VTE prophylaxis in acute medical inpatients; treatment of diagnosed VTE; and anticoagulation for patients with unstable angina and non-ST-elevation myocardial infarction (UA/NSTEMI). Previously published cost-effectiveness analyses for each indication were combined into a single model and updated to 2002 prices. The number of patients given heparin in each indication was estimated from the pharmacy records of a large UK teaching hospital. The model estimated the use of drugs, staff time, clinical events and resource use resulting from anti-coagulation. Costs were estimated from the perspective of the hospital and the UK National Health Service.Results: Total annual cost was estimated to be £3.2 m (single LMWH), £4.4 m (UFH only) and £3.7 m (multiple heparins). The largest expected cost savings from using a single LMWH compared to UFH only resulted from reduced hospital stay for DVT treatment, reduced revascularisation in UA/NSTEMI and fewer VTE events in orthopaedic surgery. Expected cost savings from using a single LMWH compared to multiple heparins were more modest.Conclusion: Sub-optimal choice of anticoagulants may result in substantial excess costs elsewhere in the hospital. [ABSTRACT FROM AUTHOR]

Objective: To describe the methodology used to identify United Kingdom (UK) hospital pharmacy practice research work from the last two decades.Method: A comprehensive search for citations that appeared to contribute to the overall evidence or in some way measure, demonstrate or evaluate the effectiveness of UK hospital pharmacy practice. This involved a search of thirteen electronic databases covering a wide variety of UK, European and international publications, hand searching of selected UK journals and conference proceedings, a written request for details sent to all UK Chief Pharmacists and Directors of Pharmacy and a bibliography search of each reference identified. All appropriate references were then added to a single computer database. Main outcome measure: Number of references identified by each strand of the search strategy. Results: The search initially highlighted a total of 10,099 articles from the thirteen reference databases, but only 281 were considered suitable for inclusion in the final review. Hand searching of the selected journals and conference proceedings yielded another 173 references and the written requests to hospital chief pharmacists resulted in another 128 references being identified. Finally, bibliography searches of the articles identified by the above three methods resulted in another 242 references, bringing the total number of references to 824. Conclusion: This paper describes a strategy to identify a comprehensive collection of citations supporting the evidence for the effectiveness of hospital pharmaceutical services in the UK. The large number of references identified demonstrate that hospital pharmacists in the UK make significant contributions to both the research literature and to patient care. However, database searches alone highlighted just 34% of the total references finally included in this study, demonstrating that pharmacy practice research work may be difficult to access by conducting database searches alone. The results from this project provide a resource for the profession and can be utilised as a foundation for future developments in both the delivery and research of hospital pharmacy practice. [ABSTRACT FROM AUTHOR]

The Hospital Pharmacy Initiative was a Department of Health funded programme in England between 2003 and 2006. It has produced a number of benefits that are organizational, educational, professional, clinical and economic. The opportunity to share experiences, identify what works well and collaborate across national boundaries to address a problem that is taxing all governments and NHS acute trusts and causes considerable concern to patients and their families should be a common goal for the UK. [ABSTRACT FROM AUTHOR]

This report describes the work of the Human Prescribing Subgroup of the Department of Health (DH) Specialist Advisory Committee on Antimicrobial Resistance over a period of 3 years from 2003. It describes the coordination and outputs from the DH Pharmacy Initiative for promoting prudent use of antibiotics in hospitals. The production and dissemination of a template have supported this and have provided a format for acute hospitals to develop antimicrobial guidelines. Engagement with key stakeholders has enabled antimicrobial use and resistance to be highlighted as an important policy issue. Work with the Healthcare Commission has informed the development of high-level indicators that have been incorporated into national audits of acute hospitals and recommendations in a national report ‘The Best Medicine’. The development of a quantitative database of antimicrobial usage has been an important feature of this work. Three annual national multidisciplinary conferences have been organized where work has been presented. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to determine the association between the reduction in the number of Clostridium difficile infection (CDI) cases reported by the English National Health Service (NHS) hospitals and concurrent antimicrobial use., Methods: A retrospective ecological study for January 2005 to December 2008 was conducted using data from 26 of the 29 NHS trusts (i.e. a trust manages one or more hospitals) located in the North West Strategic Health Authority of England. Antimicrobial use data, for patients of all ages, were provided by IMS Health, and CDI case data for patients aged ≥65 years were provided by the Health Protection Agency. Antimicrobial use was converted into defined daily doses (DDDs). The overall association between antimicrobial use and CDI for the trusts was investigated using multilevel models., Results: Our study shows a positive significant association between the CDI cases and the use of the following antimicrobials: ‘third-generation cephalosporins’ [11.62 CDI cases per 1000 DDDs; 95% confidence interval (CI), 5.92–17.31]; ‘fluoroquinolones’ (4.79 CDI cases per 1000 DDDs; 95% CI, 2.83–6.74); and ‘second-generation cephalosporins’ (4.25 CDI cases per 1000 DDDs; 95% CI, 1.66–6.83). The strength of this association was not significantly different (95% CI) among the antimicrobial groups., Conclusions: This study shows that the reduction in the number of CDI cases reported by the English NHS hospitals is associated with concurrent reductions in antimicrobial use. This means that the number of CDI cases over time decreased in a similar fashion to the usage of various antimicrobials.