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Antimicrobial Stewardship Antimicrobial Stewardship: Systems and Processes for Effective Antimicrobial Medicine Use

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Antimicrobial Stewardship Antimicrobial Stewardship: Systems and Processes for Effective Antimicrobial Medicine Use NICE Medicines and prescribing centre DRAFT for consultation Antimicrobial stewardship Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use Medicines practice guideline Appendices August 2015 National Institute for Health and Care Excellence Disclaimer This guideline represents the views of NICE and was arrived at after careful consideration of the evidence available. Those working in the NHS, local authorities, the wider public, voluntary and community sectors and the private sector should take it into account when carrying out their professional, managerial or voluntary duties. Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Copyright National Institute for Health and Care Excellence 2015 Declarations of interest Contents Appendices .......................................................................................................................... 5 Appendix A: Declarations of interest ............................................................................ 5 A.1 Guideline development group (GDG) members .............................................. 5 A.2 NICE project team and additional GDG meeting attendeesError! Bookmark not defined. Appendix B: Scope .................................................................................................... 20 Appendix C: How this guideline was developed ......................................................... 26 C.1 Search strategies for the guideline................................................................ 26 C.1.1 Scoping searches ........................................................................... 26 C.1.2 Main searches ................................................................................ 28 C.1.3 Economic evaluations and quality of life data .................................. 37 C.2 Review questions and review protocols ........................................................ 41 C.2.1 Reducing antimicrobial resistance ................................................... 41 C.2.2 Decision making ............................................................................. 44 C.2.3 Barriers to decision making ............................................................. 48 C.2.4 Timely adoption and diffusion of a new antimicrobial ...................... 50 C.3 Clinical consort diagrams .............................................................................. 53 C.3.1 Reducing antimicrobial resistance ................................................... 53 C.3.2 Decision making ............................................................................. 54 C.3.3 Barriers to decision making ............................................................. 55 C.3.4 Timely adoption and diffusion of a new antimicrobial ...................... 55 C.4 Economic consort diagrams.......................................................................... 56 C.4.1 Reducing antimicrobial resistance ................................................... 56 C.4.2 Decision making ............................................................................. 56 C.4.3 Barriers to decision making ............................................................. 56 C.4.4 Timely adoption and diffusion of a new antimicrobial ...................... 56 C.5 Clinical excluded studies .............................................................................. 57 C.5.1 Reducing antimicrobial resistance ................................................... 57 C.5.2 Decision making ............................................................................. 75 C.5.3 Barriers to decision making ............................................................. 91 C.5.4 Timely adoption and diffusion of a new antimicrobial ...................... 98 C.6 Economic excluded studies .......................................................................... 98 C.6.1 Reducing antimicrobial resistance ................................................... 98 C.6.2 Decision making ............................................................................. 98 C.6.3 Barriers to decision making ............................................................. 99 C.6.4 Timely adoption and diffusion of a new antimicrobial ...................... 99 Appendix D: Clinical evidence tables and GRADE profiles ....................................... 100 D.1 Evidence tables .......................................................................................... 100 D.1.1 Reducing antimicrobial resistance. ................................................ 100 National Institute for Health and Care Excellence 2015 3 Appendices Declarations of interest D.1.2 Additional evidence tables for reducing antimicrobial resistance (de-escalation) .............................................................................. 125 D.1.3 Decision making ........................................................................... 131 D.1.4 Barriers to decision making ........................................................... 169 D.1.5 Timely adoption and diffusion of a new antimicrobial .................... 181 D.2 GRADE profiles and forest plots ................................................................. 183 D.2.1 Reducing antimicrobial resistance. ................................................ 183 D.2.2 Decision making ........................................................................... 204 D.2.3 Barriers to decision making ........................................................... 210 D.2.4 Timely adoption and diffusion of a new antimicrobial .................... 211 Appendix E: Economic evidence tables ................................................................... 213 E.1 Reducing antimicrobial resistance. ............................................................. 213 E.2 Decision making ......................................................................................... 213 E.3 Barriers to decision making ........................................................................ 217 E.4 Timely adoption and diffusion of a new antimicrobial .................................. 217 Appendix F: Linking evidence to recommendations ................................................. 218 Appendix G: Organisations providing written or oral evidence .................................. 221 Appendix H: Quality assessment checklist ............................................................... 223 National Institute for Health and Care Excellence 2015 4 Appendices Declara tions of interest Appendices Appendix A: Declarations of interest A.1 Guideline development group (GDG) members Alastair Hay (Chair) GDG meeting Declaration of interest Action taken Recruitment None None First GDG meeting (3 June Member of Advisory Committee on Antimicrobial Project lead will monitor for any potential conflict. 2014) Resistance and Healthcare Associated Infection. Would like to be aware of evidence gaps and GDG Advice given regards ensuring that information learnt as research recommendations that could influence future part of the NICE guideline process is not shared with other research programme. committees/groups etc. Second GDG meeting (8 Has an interest in the longitude prize, no financial None September 2014) interests, no involvement in any new antimicrobials. Third GDG meeting (30 No changes to record None September 2014) Fourth GDG meeting (14 No financial conflicts of interest to declare. Lead a group Advice given regards ensuring that information learnt as November 2014) at the University of Bristol conducting research into part of the NICE guideline process is not shared with other primary care infections and antimicrobial resistance. committees/groups etc. Fifth GDG meeting (14 April No changes to record None 2015) Tessa Lewis (Vice-chair) GDG meeting Declaration of interest Action taken Recruitment None None First GDG meeting (3 June No changes to record None 2014) National Institute for Health and Care Excellence 2015 5 Appendices Declarations of interest GDG meeting Declaration of interest Action taken Second GDG meeting (8 No changes to record None September 2014) Third GDG meeting (30 No changes to record None September 2014) Fourth GDG meeting (14 No changes to record None November 2014) Fifth GDG meeting (14 April No changes to record None 2015) Chris Cefai GDG meeting Declaration of interest Action taken Recruitment None None First GDG meeting (3 June No changes to record None 2014) Second GDG meeting (8 No changes to record None September 2014) Third GDG meeting (30 No changes to record None September 2014) Fourth GDG meeting (14 No changes to record None November 2014) Fifth GDG meeting (14 April No changes to record None 2015) Esmita Charani (until 27 November 2014) GDG meeting Declaration of interest Action taken Recruitment None None First GDG meeting (3 June Published in peer reviewed journals. Advice given regards ensuring that information learnt as 2014). part of the NICE guideline process is not shared with other committees/groups or included within any written articles. Reminded that opinions expressed that may be relevant
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