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AMSAMSAn introduction to antimicrobial stewardshipStewardshipSurveillanceRace against resistanceABSABSABS in practice Educational ResourcesAFSAFSShape the futureAFS in practiceImplementing an AFS programmeDiagnosticsGuidelinesCase studiesAll case studiesOur CommitmentOur CommitmentOur commitment to anti-infectivesHeritageSustainability
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Support & ResourcesSupport & ResourcesVideosMaterialsOnline LearningOnline LearningHomeINSPIRE To: Change the CourseLondon AMS SeriesNorth West England AMS SeriesInfectious Thinking Podcasts

Information on how to access prescribing information and adverse event reporting can be found at the bottom of the page.

An introduction to antimicrobial stewardship

Antimicrobial stewardship (AMS) is an approach aimed at promoting sensible use of antimicrobials, in an effort to preserve their future effectiveness.1,2 In clinical practice, stewardship translates as coordinated action to improve the use of anti-infectives and measure its appropriateness.1

The overarching goal of AMS is 3-fold:3

  1. Prescribe the appropriate anti-infective to patients
     
  2. Prevent antimicrobial overuse, misuse, and abuse
     
  3. Minimise the development of resistance

The principles of AMS are based on Public Health England’s ‘Start Smart – Then Focus’ guide, first published in 2011 and last updated in 2015, with information on implementing a stewardship programme, prescribing guidelines, and quality assurance measures.4 However, the toolkit was developed for broad antimicrobial use, without guidance specific to antifungal stewardship.

Antimicrobial, antibacterial, and antifungal stewardship

The terms ‘antimicrobial’ and ‘antibacterial’ are often used interchangeably, particularly in the context of resistance and stewardship. However, it’s important to note that antimicrobial is an umbrella term that covers all anti-infective therapies, including antivirals, antifungals, antibiotics, and antiparasitics.1,5

Antibacterial and antifungal stewardship are two subsets of antimicrobial stewardship, with their own targets and interventions.6
Scroll left to view table
  Antibacterial stewardship Antifungals
Target drug Antibiotics Antifungals
Setting Primary and secondary care  Mainly secondary care
Specialities involved All Few
  • Mainly haemato-oncology, organ transplantation, critical care, gastrointestinal surgery and respiratory
Typical drug use Treatment or single-dose prophylaxis Prolonged prophylaxis and treatment
Drug availability and cost Many drugs, £-££s  Fewer drugs, ££-£££s
Resistance Increasing multi-drug resistance Mainly single-drug resistance
Pharmacokinetics Less complex
  • Few drug interactions
Complex
•    Many drug interactions and contraindications
•    TDM required (for certain azoles)
Funding stream National tariff No national tariff (exempt from payment by results)
Our pledge 

At Pfizer, we have a long-standing commitment to tackling antimicrobial resistance, collaborating with the NHS and other stakeholders. We support an extensive range of initiatives that go beyond the sale of our medicines, including public awareness and educational programmes, education of healthcare professionals, responsible commercial and manufacturing activities, and investment in surveillance programmes.

AMS Read about establishing an AMS programme Find out more Loading Learn more about AFS in practice Read more Loading

ABS, antibacterial stewardship; AFS, antifungal stewardship; AMS, antimicrobial stewardship; PHE, Public Health England; TDM, therapeutic drug monitoring.

Prescribing Information:

Click here for CRESEMBA® (isavuconazole) prescribing information
Click here here for Zavicefta® (ceftazidime and avibactam) prescribing information
Click here for Zinforo® (ceftaroline fosamil) prescribing information

References:

NICE Guideline. Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. 2015. Available at: https://www.nice.org.uk/guidance/ng15/resources/antimicrobial-stewardship-systems-and-processes-for-effective-antimicrobial-medicine-use-pdf-1837273110469 Accessed August 2022.Mendelson M et al. Clin Microbiol & Infect. 2019;26(4):P447–P453.Doron S and Davidson LE. Mayo Clin Proc 2011;86(11):1113–1123.Public Health England. Start Smart – Then Focus. Antimicrobial Stewardship Toolkit for English Hospitals. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/417032/Start_Smart_Then_Focus_FINAL.PDF Accessed August 2022.CIDRAP. What is antimicrobial stewardship? Available at: https://www.cidrap.umn.edu/asp/what-is-antimicrobial-stewardship. Accessed August 2022.Whitney L and Bicanic T. Antimicrobial Stewardship. In: Laundy M, Gilchrist M, Whitney L, editors. Oxford Medicine Online; 10.1093/med/9780198758792.001.0001: Oxford University Press; 2016.
PP-CRB-GBR-1522. August 2022.

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search 

for MHRA Yellow Card in Google Play or Apple App Store

 

Adverse events should also be reported to Pfizer Medical Information on 01304 616161

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