Antimicrobial stewardship: changing risk-related behaviours in the general population (Joint NICE and Public Health England guideline)

This new guideline aims to make people aware of how to correctly use antimicrobial medicines and the dangers associated with their overuse and misuse in order to reduce antimicrobial resistance. It also includes measures to prevent and control infection.

Recommendations made by NG63 cover the following areas:

  • overarching principles
  • local system-wide approaches to reducing inappropriate antimicrobial demand and use
  • local system-wide approaches to preventing and limiting the spread of infection
  • childcare and education providers
  • prescribers, primary care, and community pharmacy teams.

Actions for prescribers, primary care and community pharmacy teams

Guidance should be read alongside the recommendations on prescribing (recommendations 1.1.24 to 1.1.37) in NICE’s guideline on antimicrobial stewardship. See also NICE’s guideline on sepsis: recognition, diagnosis and early management.

1.5.1 When people ask about managing self-limiting infections:

  • Share advice on self-care for each of the symptoms.
  • Use and share resources that provide written advice to encourage people to change their behaviour (see recommendation 1.2.1).
  • Verbally emphasise the key messages given in the written resources.
  • Display resources that provide or signpost to advice and information about self-care; for example,NHS Choices, 111 and local advice or helplines.
  • Signpost them to further information to read at home, such as online advice.
  • Discuss with them whether taking or using an antimicrobial is the most appropriate option (see the recommendation on discussions with patients and family members or carers under ‘antimicrobial prescribing’ in NICE’s guideline on antimicrobial stewardship).
  • Raise awareness of community pharmacists as an easily accessible first point of contact for advice about managing a self-limiting infection.

1.5.2 Consider using computer prompts or decision support aids to prompt healthcare professionals to share information with people on the appropriate use of antimicrobials, self-care and safety netting (see NICE’s guideline on antimicrobial stewardship).

If antimicrobials are prescribed or supplied:

1.5.3 Share verbal advice and written information that people can take away (see recommendation 1.5.1) about how to use antimicrobials correctly, including:

  • not sharing prescription-only antimicrobials with anyone other than the person they were prescribed or supplied for
  • not keeping them for use another time
  • returning unused antimicrobials to the pharmacy for safe disposal and not flushing them down toilets or sinks.

1.5.4 If the person has been given a back-up (delayed) prescription, tell them:

  • How to self-care to manage their symptoms.
  • What the antimicrobials would be used for, if needed.
  • How to recognise whether they need to use the antimicrobials, and if so:
    • how to get them
    • when to start taking or using them
    • how to take or use them

If antimicrobials are not prescribed or supplied

1.5.5 Give people verbal advice and share written information that they can take away about how to manage their infection themselves (see recommendation 1.5.1).

General advice in primary care and community pharmacies

1.5.6 Share safety-netting advice with everyone who has an infection (regardless of whether or not they are prescribed or supplied with antimicrobials). This should include:

  • how long symptoms are likely to last with and without antimicrobials
  • what to do if symptoms get worse
  • what to do if they experience adverse effects from the treatment
  • when they should ask again for medical advice.

For more information see https://www.nice.org.uk/guidance/ng63