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This purpose of this policy is to promote antimicrobial stewardship by reserving the use of specific antimicrobials for special circumstances (e.g resistant organisms), in line with WHO AWaRe recommendations and local epidemiology. The aim is to reduce the development of resistance and preserve the efficacy of these valuable agents for now and in the future.
The policy is for use within all clinical areas at the Royal Hospital for Children, NHS Greater Glasgow & Clyde. Protected antimicrobials may only be used following approval from a Microbiologist or Infectious Diseases Consultant unless used in line with approved local guidelines as outlined below.
BACKGROUND: In 2019 the World Health Organisation published the antibiotic AWaRE classification database following recommendations from the WHO Expert Committee on Selection and Use of Essential Medicines. AWaRE classifies antibiotics in to three stewardship groups:
Antimicrobials MUST be prescribed:
For all antimicrobial prescribing the following must be recorded in the patient’s medical notes AND on the drug Kardex:
For PROTECTED antimicrobials (WATCH Abx outside of approved use; all RESERVE antibiotics) the following also applies:
*Note: Where a protected antimicrobial is commenced out of standard Pharmacy operating hours, a limited supply will be available. Pharmacy must be contacted early the following working day to obtain further supply and avoid delay in treatment.
The information collected within the ‘Protected Antimicrobial Use Form’ will be used to aid surveillance of antimicrobial use and facilitate the identification of areas where increased support with antimicrobial stewardship can be targeted.
PROTECTED ANTIBIOTICS: RESERVE
RESTRICTED: RECOMMENDATION/ APPROVAL required from Microbiology or Infectious Disease Consultant prior to initiating therapy*
‘Protected Antimicrobial Use’ form mandatory for all meropenem and nitrofurantoin (liquid)
*Micro/ID approval not required where meropenem is used as second line therapy for Haematology/oncology patients in line with approved NHS GGC guidelines. A PAU form is still required for surveillance purposes.
PROTECTED ANTIBIOTICS: WATCH
RESTRICTED: Must be used in accordance with approved NHS GGC guidelines.
RECOMMENDATION/ APPROVAL required from Microbiology or Infectious Disease Consultant prior to initiating therapy outside of NHS GGC approved guidelines
‘Protected Antimicrobial Use’ form not required
ACCESS ANTIBIOTICS: ADDITIONAL RESTRICTIONS NOT APPLICABLE
NOT RESTRICTED: Recommended for use in accordance with NHS GGC guidelines.
No approval/ ‘Protected Antimicrobial Use’ form required
Last reviewed: 23 February 2021
Next review: 28 February 2024
Author(s): Susan Kafka, Advanced Pharmacist Paediatric Antimicrobials and Medicine
Approved By: Antimicrobial Utilisation Committee