Evidence
How we made the decision
How we made the decision
We check our guidelines regularly to ensure they remain up to date. We based the decision on surveillance 2 years after the publication of NICE's guideline on antimicrobial stewardship (NICE guideline NG15) in 2015.
For details of the process and update decisions that are available, see ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual.
Evidence
As well as checking any relevant policy or other guidance that had been issued or updated since the guideline was published, we also checked for relevant ongoing research. This will be evaluated again at the next surveillance review of the guideline.
See appendix A: summary of evidence from surveillance for details of all evidence considered, and references.
Views of topic experts
We considered the views of 5 topic experts, 4 of whom were members of the original guideline committee, and 1 who was a member of the committee for the quality standard associated with this guideline. Four of the topic experts agreed that the guideline does not need updating. One member noted that the guideline may need reviewing in light of the ongoing development of NICE antimicrobial prescribing guidance for managing common infections. However, it is expected that the common infections guidance will complement the antimicrobial stewardship guideline and no update is currently needed.
Experts also noted that there have been issues with implementing the guideline. Implementation is outside the scope of the surveillance process; however, comments have been passed to the relevant NICE system engagement teams for consideration.
Experts additionally raised that there has been much discussion about antimicrobial course length, and that there was insufficient evidence when the guideline was developed to inform recommendations in this area. However, they were not aware of any new evidence that would be sufficient to update recommendations.
Views of stakeholders
Stakeholders commented on the decision not to update the guideline. Overall, 10 stakeholders commented. See appendix B for stakeholders' comments and our responses.
Ten stakeholders commented on the proposal to not update the guideline: 7 agreed with the decision; 1 disagreed with the decision; and 2 did not provide a firm answer.
Issues raised in disagreement with the decision not to update were:
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Education is mentioned in the recommendations but not behavioural science.
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Although behavioural science is not specifically mentioned, changing prescribers' behaviour is a key aspect of the guideline and underpins many of the recommendations.
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Further information is needed about patient-facing interventions such as guidance about self-care, or correct use of antibiotics.
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This is covered in greater detail in the NICE guideline on antimicrobial stewardship: changing risk-related behaviours in the general population (NICE guideline NG63). A link to NICE guideline NG63 will be added to NICE guideline NG15. NICE is also producing antimicrobial prescribing guidelines for managing common infections, which include patient-facing interventions.
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The TARGET toolkit is not presented as a resource for prescribers and for managers and leads of services.
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The 'Managers and leads of services' section links to the list of further resources, which includes the TARGET antibiotics toolkit.
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Research recommendations do not include randomised controlled trials (RCTs) to reduce unnecessary antibiotic prescribing, nor to reduce the number of patients who expect antibiotics/go to the GP with self-limited infections.
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RCTs were found for reducing unnecessary antibiotic prescribing when the guideline was developed, and NICE is aware of and monitoring further trials in this area. Patients expecting antibiotics/with self-limited infections is of greater relevance to NICE guideline NG63, which includes research recommendations relevant to these issues.
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There is no direct reference to infection prevention and control.
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The scope of NICE guideline NG15 excludes infection prevention and control measures, which is covered by NICE guideline CG139, NICE guideline PH36, and NICE quality standard 61. These are linked to from NICE guideline NG15.
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For full details of the stakeholder comments and NICE's response see appendix B.
See ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual for more details on our consultation processes.
NICE Surveillance programme project team
Kay Nolan
Associate Director
Philip Alderson
Consultant Clinical Adviser
Judith Thornton
Technical Adviser
Patrick Langford
Technical Analyst
The NICE project team would like to thank the topic experts who participated in the surveillance process.
ISBN: 978-1-4731-2785-2
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