29th February 2024

Explore the latest Editors’ picks from Journal of Antimicrobial Chemotherapy (JAC) and JAC-Antimicrobial Resistance (JAC-AMR). The focus this month is on stewardship, with a look at BSAC’s Global Antimicrobial Stewardship Accreditation Scheme, an assessment of how the TARGET toolkit can support pharmacy technicians, and studies examining appropriateness of prescribing in children, neutropenic fever patients and a low-income setting. And a review of systematic reviews asks whether nirmatrelvir/ritonavir is effective for treatment of COVID-19.

Jacqueline Sneddon and others, Accreditation of antimicrobial stewardship programmes: addressing a global need to tackle antimicrobial resistance. JAC-Antimicrobial Resistance 2024, dlae007, https://doi.org/10.1093/jacamr/dlae007

Sneddon et al. explain BSAC’s Global Antimicrobial Stewardship Accreditation Scheme (GAMSAS), which aims to improve and recognize strong antibiotic stewardship programmes in hospitals worldwide. GAMSAS offers accreditation based on pre-defined standards and involves an application process, self-assessment and site visits. In its first year, the programme accredited 10 organizations, including the first in Africa. They encourage more hospitals to join and national policy leaders to consider adopting this approach.

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Alishah Lakha and others, Evaluating the role of primary care pharmacy technicians in antimicrobial stewardship (AMS) and acne management using TARGET resources. JAC-Antimicrobial Resistance 2024, dlae011, https://doi.org/10.1093/jacamr/dlae011

Lakha et al. explored whether the UK’s TARGET resources improve pharmacy technicians’ capability, opportunity and motivation to manage acne in patients. Those familiar with TARGET felt more capable and had more opportunities to help compared with those unfamiliar with the toolkit, while both groups showed high motivation. Overall, the TARGET resources were useful for supporting pharmacy technicians in acne management and wider promotion of the toolkit among pharmacy technicians is needed.

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Hannelore Dillen and others, Factors associated with inappropriateness of antibiotic prescriptions for acutely ill children presenting to ambulatory care in high-income countries: a systematic review and meta-analysis. Journal of Antimicrobial Chemotherapy 2023, dkad383, https://doi.org/10.1093/jac/dkad383

In this systematic review, Dillen et al. analysed factors influencing inappropriate antibiotic use for sick children in high-income countries. They found that ear infections, GPs and rural locations were linked to higher rates of unnecessary antibiotics and should be prioritized in stewardship interventions. A standardized definition for ‘appropriateness’ is needed for evaluation of antimicrobial stewardship programmes.

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Nikhil Singh and others, Antimicrobial use and appropriateness in neutropenic fever: a study of the Hospital National Antimicrobial Prescribing Survey data. Journal of Antimicrobial Chemotherapy 2024, dkae015, https://doi.org/10.1093/jac/dkae015

Singh et al. examined antibiotic use for neutropenic fever in cancer patients using an Australia national dataset (Hospital NAPS). Overall, most prescriptions were appropriate, with piperacillin/tazobactam the most common. However, they identified some areas for improvement including piperacillin/tazobactam dosing and appropriateness of prescribing practices in children and private hospitals, which can be used to inform updated treatment guidelines.

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Steward Mudenda and others, Hospital prescribing patterns of antibiotics in Zambia using the WHO prescribing indicators post-COVID-19 pandemic: findings and implications. JAC-Antimicrobial Resistance 2024, dlae023, https://doi.org/10.1093/jacamr/dlae023

In a Zambian hospital, Mudenda et al. found high rates of antibiotic use, including injectables. While most (77.1%) came from the WHO-recommended Access list, the overall usage suggests a need for better control. Potential targets for implementing antimicrobial stewardship in this hospital include assessing prescribing against AWaRe guidance, reviewing the need for IV antibiotics and any barriers to de-escalation, and reducing the prescription of multiple empirical antibiotics.

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Mario Cruciani and others, Nirmatrelvir/ritonavir for COVID-19: an overview of systematic reviews. Journal of Antimicrobial Chemotherapy 2023, dkad376, https://doi.org/10.1093/jac/dkad376

This overview of systematic reviews by Cruciani et al. examined 16 studies on nirmatrelvir/ritonavir for COVID-19. Their findings showed low to moderate certainty that it reduces mortality, hospital admission and disease progression compared with controls, with no significant increase in overall or serious side effects. Confidence in the quality of results from the systematic reviews is high.

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