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Safeguarding antimicrobial use in a pandemic

Dr Jacqueline Sneddon, head of the Scottish Antimicrobial Prescribing Group.


Although the COVID-19 pandemic is still with us, many parts of the NHS in Scotland are restarting work that had to be paused, while keeping their focus on the virus.


Dr Jacqueline Sneddon – lead for the Scottish Antimicrobial Prescribing Group (SAPG), part of Healthcare Improvement Scotland – reflects on the big part played by a small group in responding to the pandemic and looks at what’s next.


“The impact of the COVID-19 pandemic brought challenges and opportunities for the SAPG.


“Our group works with NHS boards across health and care settings in Scotland to safeguard antibiotics against the global threat of antimicrobial resistance. When both the group’s committee and project group meetings were paused, it meant that that routine work for the group was also suspended.


“We’re a small and agile team of just three employees, including me, plus one day per week from our Chair, Dr Andrew Seaton from NHS Greater Glasgow and Clyde, but with a committee of national experts and clinical staff from across Scotland, as well as several project steering groups.


“Initially I was seconded to support first the Medicines and Pharmacy team within Healthcare Improvement Scotland (of which SAPG is a part), and then to NHS Lothian to support the ICU pharmacy service.


“Marion Pirie, our team’s Project Officer, took on part-time work with NHS 24 supporting staff training by role-playing real-life patient calls.


“Meanwhile, Lesley Cooper, our Health Service Researcher, devoted her time to finalising evidence reviews for two of our projects – penicillin allergy de-labelling and use of antibiotics towards the end of life – which have now been submitted for publication.


“There was also time to write up our findings from global health partnership work we’d just recently completed with two hospitals in Ghana for future publication.”


Covid-19 and antibiotics


“But we couldn’t entirely take our eye off COVID-19.


“The pandemic meant that we needed to be sure that the use of antibiotics was still appropriate and that clinicians had the information they needed.


“Literature reports of overuse of antibiotics in other countries led to SAPG producing advice to support antimicrobial teams in NHS boards to maintain stewardship of antibiotics in hospitals and care homes.


“We recognised an opportunity and need to explore the impact of COVID-19 on hospital antibiotic prescribing, given emerging data form China and other parts of the UK, so SAPG led a point-prevalence survey audit examining epidemiological, clinical and prescribing data from eight boards.


“Data was captured from over 800 patients with suspected or proven COVID-19 across 15 acute hospitals (about one-third of all hospitalised patients with COVID-19 in Scotland at the time) during the last ten days in April.


“The study generated a huge amount of data that Lesley and colleagues in Public Health Scotland analysed and this provided reassurance that antibiotic use in Scotland was compliant with local guidelines, with lower use in COVID-19 patients than reported elsewhere.


“Thankfully there was no increased use of broad-spectrum antibiotics that drive resistance although the emerging problem of secondary bacterial infections in critical care was observed.


“One paper has been submitted for a publication focused on the epidemiology of antibiotic prescribing in COVID-19 and a second on the management of suspected respiratory infections in the context of COVID-19 is underway.”


Emerging from lockdown


“As we gradually emerge from lockdown, SAPG work has restarted with our first virtual committee meeting recently attended by 32 members. On the agenda, as well as the hospital audit data, was a discussion of data on GP practice antibiotic prescribing during COVID-19, and hearing about the challenges that antimicrobial teams had faced.


“All of this information will allow us to continue to learn and will inform the SAPG work programme to ensure the NHS in Scotland continues to use antimicrobials optimally to preserve antibiotics for future generations.


“We then turned our attention to our project groups on penicillin allergy and end-of-life antibiotics, to finalise outputs and agree plans for implementation as well as publications on our project development processes.


“We’re now working with our SAPG Public Partners to produce a patient version of recommendations for use of antibiotics towards the end of life to support patients and their families in shared decision making.


“As I reflect on the lessons of the pandemic and the way forward for the group, it strikes me just how much COVID-19 has brought people together – we see that in society, but also within organisations like our own.


“Our team is contributing to cross-organisational work on older peoples’ systems and primary care where our experience of working with care homes, and with GP Practices will help to inform and support future priorities. 2020 marked 12 years since SAPG was formed and since I joined the organisation.


“We’ve achieved so much by working in partnership with health and care professionals across the country. Although it’s been a difficult year for everyone, we can only look forward, to continue the fight against antimicrobial resistance, and to face whatever new challenges lie ahead.”


The Scottish Antimicrobial Prescribing Group is part of Healthcare Improvement Scotland.


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