Antimicrobial Awareness Week

Join us in recognising World Antimicrobial Resistance (AMR) Awareness Week from 18 – 24 November 2024.

This year's theme is "Educate. Advocate. Act Now". World Antimicrobial Resistance Awareness Week is a global campaign to highlight the critical importance of using antimicrobials judiciously. As antimicrobial resistance continues to rise, we must take proactive steps to ensure these lifesaving medicines remain effective for future generations.

EDUCATE – But I am feeling much better

BH, a 62-year-old man, was admitted to a respiratory ward of a metropolitan hospital after presenting to the emergency department with tachypnoea (abnormally rapid breathing), tachycardia (elevated heart rate) and an oxygen saturation of 92% on room air. Physical examination, chest x-ray and pathology results showed that he had community-acquired pneumonia. This was assessed as being moderate in severity. The medical team commenced him on intravenous benzylpenicillin and oral doxycycline in accordance with recommendations in the Therapeutic Guidelines: Antibiotic to cover for potential pathogens that cause community-acquired pneumonia.

After 3 days of treatment, BH showed significant improvement. His tachypnoea and tachycardia had resolved, and his oxygen saturation was now measuring at 98% on room air. His chest x-ray showed signs of resolving pneumonia, and he was clinically stable. The medical team deemed him appropriate to transition to only oral antibiotics to treat his pneumonia and for discharge from hospital. They sent a prescription to the pharmacy with the following medicines:

1. amoxycillin 1 gram orally, three times a day for 2 more days
2. doxycycline 100 mg orally, twice a day for 2 more days.

As BH was feeling much better, he expressed to the medical team that he would like to avoid taking any more antibiotics. Knowing the importance of completing a course of antibiotics, and the potential risks of antimicrobial resistance, the medical officer called on the ward pharmacist to EDUCATE BH on his discharge medicines and the importance of completing the course of antibiotics.

The pharmacist discussed with BH that the switch to oral antibiotics would allow him to manage his treatment at home more easily and it was essential to complete the course to avoid the treatment failing and help prevent the development of antibiotic resistance.

Education must be provided to patients to ensure an understanding that an improvement in symptoms or “feeling better” does not always mean the infection has been effectively treated. Evidence-based guidelines recommend the shortest, but most appropriate, treatment course to ensure infections are completely treated before stopping treatment to reduce the chance of antimicrobial resistance.

ADVOCATE – Let's get this on target

JK, a 54-year-old female, was admitted to hospital with severe leg cellulitis. She was commenced on vancomycin in consultation with the infectious diseases specialist due to blood cultures returning a positive result for methicillin-resistant Staphylococcus aureus (MRSA). JK weighed 78 kg and had a calculated creatinine clearance (CrCl) of 80 mL/min.

She was charted a loading dose of vancomycin 2 g intravenously, followed by vancomycin 1.5 g intravenously, twice daily thereafter. The medical team collected a trough level immediately prior to the fourth dose, which returned as 12.2 mg/L (target range 15 to 20 mg/L).

While reviewing patients on the ward, the pharmacist discovered JK’s subtherapeutic vancomycin trough level. Recognising the importance of dosing this medicine appropriately, the pharmacist alerted the medical team to ADVOCATE for:

• an increase in the vancomycin dose to achieve a target trough level – the pharmacist calculated the required dose to be 2 g twice daily
• continued monitoring, including regular therapeutic levels, renal function and observations.

A couple of days later, JK's trough level had returned within the target range and she was showing signs of improvement.

It is essential that target therapeutic levels are achieved for particular antimicrobials, including vancomycin to ensure optimal dosing and avoid treatment failure, prolonged infection, and the development of antimicrobial resistance.

ACT NOW – More than a cold

MC, a 4-year-old boy, arrived at a small regional hospital with a severe sore throat, difficulty swallowing, fever (39.4°C), fatigue, and weakness. He also had a sandpaper-like rash on his hands, feet, and trunk. Nurses, aware of a recent rise in invasive group A streptococcal (iGAS) infection, raised concerns with senior medical staff. MC's mother was worried that his condition was worsening, and asked, "Could it be sepsis?".

The medical team listened to her concerns and recognised possible signs of sepsis. Symptoms in children include a lack of urination, a new or non-fading rash, and difficulty breathing. The team decided to ACT NOW and initiate the paediatric sepsis pathway. They took blood cultures, a throat swab, a urine culture, and lactate levels. He received timely antibiotic therapy and intravenous fluids.

Group A Streptococcus can cause a range of infections, from mild to life-threatening conditions. Such infections can include throat infections (pharyngitis), tonsil infections (tonsillitis), scarlet fever, skin infections like impetigo, cellulitis or necrotising fasciitis and streptococcal toxic shock syndrome. Early detection and treatment are crucial.

Due to the severity of his condition, MC was transferred via the Newborn and Paediatric Emergency Transport Service (NETS) to a larger facility. With prompt care, he made a full recovery.

Timely, targeted treatment and escalation in sepsis can save lives, and listening to parents' concerns is vital for ensuring the best outcomes for paediatric patients.

NSW Health has developed resources and factsheets on invasive group A streptococcal.

The CEC has developed resources to support antimicrobial stewardship (AMS) programs available through the AMS webpage.

For further information or advice about promoting World Antimicrobial Resistance (AMR) Awareness Week in NSW public hospitals, please send us an email.