What’s in the web for family physicians – Antimicrobial resistance

Wilbert WB Wong 王維斌，Alfred KY Tang 鄧權恩

HK Pract 2020;42:23-24

Antimicrobial Resistance (AMR) has been a growing threat to effective treatment of an increasing range of infections caused by different organisms, leading to reduced efficacy of antimicrobials, making the treatment of patients difficult, costly or sometimes impossible. It is therefore important for family physicians to keep themselves updated on this topic.

Antimicrobial resistance overview

This webpage of the WHO website gives an overview on the situation on Antimicrobial resistance worldwide. The page offers fact sheets which explain the AMR problem, and provides information on different measures and methods to deal with the situation.

“Superbugs” has become a major concern because a resistant infection may kill, can spread to others, and imposes huge costs to individuals and society. Publications and works of WHO on the AMR issue, and video recording of the Sixty-ninth World Health Assembly on AMR can also be found. (https://www.who.int/mediacentre/ events/2016/wha69/topical-discussions/en/)

Antibiotic resistance is present in every country. Resistance in Klebsiella pneumoniae as a major cause of hospital-acquired infection, E. coli in urinary tract infection, gonorrhoea in sexually transmitted disease are on increasing trend.

CHP: Thematic webpage on antimicrobial resistance

In view of the threat of AMR to global public health, the HKSAR Government announced in the 2016 Policy Address to set up a High Level Steering Committee on AMR (HLSC) to formulate strategies and implement actions. Chaired by the Secretary for Food and Health, HLSC comprises representatives from relevant Government departments, public and private hospitals, healthcare organizations, academia and relevant professional bodies.

The website appeals to general public not to demand antibiotics from doctors, follow doctors’ instructions to complete full course of antibiotics, wear mask, washing hands and complete vaccination schedule to prevent antimicrobial resistance. There are also video presentations of a Regional Symposium on AMR held in Hong Kong in November 2018 (https://www.chp.gov.hk/en/static/101126.html)

Hong Kong strategy and action plan on antimicrobial resistance (2017-2022)

This Hong Kong Strategy and Action Plan on Antimicrobial Resistance (2017-2022) (Action Plan) outlines the status of antimicrobial resistance (AMR) in the global and local context. It provides a list of actions and activities that the Hong Kong Special Administrative Region Government is planning to pursue to contain the growing threat of AMR in Hong Kong. The Action plan proposed recommendations in six key areas (i) to strengthen knowledge through sur veillance and research; (ii) to optimise use of antimicrobials in humans and animals; (iii) to reduce incidence of infection through effective sanitation, hygiene and preventive measures; (iv) to improve awareness and understanding of AMR through effective communication, education and training; (v) to promote research on AMR and (vi) to strengthen partnerships and foster engagement of relevant stakeholders.

IMPACT 5th edition

IMPACT stands for “Interhospital Multi-disciplinary Programme on Antimicrobial ChemoTherapy”. The IMPACT guideline was first developed in 1999 and was initially launched in a local hospital, but has since then extended to become a territory-wide reference for local medical practitioners. IMPACT focuses on promoting the use of the right antimicrobials in the right way for hospital infections. There are coverage on antibiotic-resistant organisms, various antimicrobials, as well as AMR in specific clinical conditions and settings. The publication was based on experience in local epidemiology and insights from local experts. The content has been extensively reviewed and recommendations carefully considered after a review of the evidence base; highlighting the antimicrobial agents with a strong link to development of multidrug-resistant organisms or situations where dosing is complicated. This site contains recommendation for the empirical therapy of common infections which is very useful in daily practice. Appropriate comments are provided, and it indicates the situations when the advice of a specialist should be sought.

The publication is freely available at the homepages of the partner organizations and made accessible as an app (Android and iOS) and website for mobile PC and phones. Features that are only available in the app version include medical calculators and up-to-date antibiograms from the Hospital Authority. A part on tuberculosis has been added to address the rising concern on drug resistance.

Antibiotics stewardship program (ASP) in primary care

CHP outlines its policy that an Antibiotic stewardship programme (ASP) across the healthcare systems could improve the prevalence of AMR. Evidence-based clinical guidelines would be an essential component of ASP to ensure that patients receive the right antibiotic, at right dose, at the right time, and for the right duration. This would in turn ensure the best clinical outcome for the treatment or prevention of infection while producing the fewest possible side effects and a low risk for subsequent resistance.

Primary care is the first level of care in the whole healthcare system and family doctors are the main providers in tackling AMR problem by reducing unnecessary use of antibiotics. Resistance develops more rapidly through the misuse and over use of antimicrobials. In this connection, Centre of Health Protection of the Department of Health rolled out the “Antibiotic Stewardship Programme in Primary Care”, aiming to optimize the use of antibiotics by providing evidence-based antibiotic prescription guidance for common infections in community for doctors and healthcare professionals as reference. The guidance notes are updated based on local epidemiology and international best practice.

There are also patient pamphlets and educational materials on “URTI – Do you really need antibiotics?”, “Be Smart! What you should know about antibiotics” and “Tips for Taking Antibiotics”

US centres for disease control and prevention

AMR is listed as one of the spotlight topics in the Emerging Infectious Diseases (EID) journal of the CDC website. This website contains update articles from different countries on the topic of antimicrobial resistance. Antibiotics and similar drugs, together called antimicrobial agents, have been used for the last 70 years to treat people who have infectious diseases. Since the 1940s, these drugs have greatly reduced illness and death from infectious diseases. However, these drugs have been used so widely and for so long that the infectious organisms the antibiotics are designed to kill are adapting to them, making the drugs less effective. It is now recognized that in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections.

European centre for disease prevention and control (ECDC)

This is a resourceful website on antimicrobial resistance by ECDC. It lists strategies, action plans, guidance documents, training courses and research projects on the prevention and control of AMR and healthcare-associated infections. Available information includes updates and publications on the topic, news and events relating to AMR, surveillance and disease data of research projects on AMR can be fou nd. Factsheets for public and health professionals are also available. Recent developments of AMR in specific diseases and conditions are also discussed.

Sources of the documents published include ECDC, EU/EEA and other countries, international and national agencies, professional societies to support healthcare professionals, hospital administrators and public health professionals.