Antimicrobial resistance and stewardship pharmacy guide

Prescribing antimicrobials

Practical tips to contribute to AMS when prescribing and dispensing antimicrobials:

• Ensure the appropriateness of an antimicrobial prescription against the national and/or local guidelines. Check if your local guidelines are available on an app or website.
• Keep a copy of your local antimicrobial/antibiotic formulary to hand — obtain one from your local NHS organisation or local area prescribing committee (England), drug and therapeutics committee (Scotland) or local health board (Wales).
• Prescribe using the RCPharm competency framework for all prescribers and the Department of Health and Social Care and UK Health Security Agency’s Antimicrobial prescribing and stewardship competencies.
• Prescribe using available toolkits, such as the Royal College of General Practitioners (RCGP) Treat Antibiotics Responsibly, Guidance, Education and Tools (TARGET) antibiotics toolkit hub.
• Clinically check the appropriateness of antimicrobials for people before prescribing.
• Confirm if a person has a true penicillin allergy or not — use our penicillin allergy checklist to inform conversations with people about penicillin allergy.
• Use narrow-spectrum antimicrobials wherever possible. If you can, avoid broad-spectrum antimicrobials.
• Refer to national prescribing guidelines, such as NICE Antimicrobial Stewardship, Scottish Intercollegiate Guidelines Network and PHE Primary Care Guidance: diagnosing and managing infections.
• You may also find our prescribing section helpful.

Dispensing antimicrobials

Clinical checks

When presented with prescriptions for antimicrobials, ask yourself:

• Is it the right drug? 
• At the right dose? 
• For the right duration? 

Our clinical checks pharmacy guide has more detail, and the TARGET antibiotics toolkit hub includes a pharmacy checklist.

If you’re dispensing and you’re concerned about the appropriateness of an antimicrobial (i.e. length of treatment) or if it’s outside the scope of the local formulary, discuss it with the prescriber. 

Access to the summary care record (SCR) (England only) can help to confirm the indication. 

Back-up or delayed prescriptions

For patients with back-up or delayed prescriptions (i.e., to be collected in a specified number of days if their symptoms haven’t improved) advise them when and how to use the prescription properly, as well as how to manage self-limiting conditions.

Educating people on the safe and effective use of antimicrobials

Provide advice and educate people on the appropriate and inappropriate use of antimicrobials

• Advise on self-limiting conditions and self-care.
• Counsel when dispensing/supplying antimicrobials.
• Provide written resources and direct patients to further advice.

Pharmacists and their teams are well-placed to do this.

Advising on self-limiting conditions and self-care

Provide advice and educate people on prevention and self-care of minor ailments (e.g., coughs, colds, ear infections, oral thrush, cystitis or sore throats)

• Reassure the patient — advise them on the average duration of common self-limiting conditions when they may start to feel better without antimicrobials. See the RCGP website for self-care information.
• Advise them to rest and drinking plenty of fluids.
• Educate patients on key signs of sepsis and when to seek further help. Visit NHS.UK or the UK Sepsis Trust.
• Encourage and advise patients how to manage self-limiting conditions and symptoms, where appropriate, e.g., with over-the-counter medicines.
• Explain why antimicrobials may not be necessary. See the RCGP website for self-care information.
• Highlight and direct patients to self-care resources, such as NHS.UK website (England), NHS Inform (Scotland) and NHS 111 Wales.
• Highlight the differences between viral and bacterial infections.
• Promote hand hygiene to prevent the spread of infection.
• Promote vaccination where appropriate (e.g. influenza, pneumococcal).
• Provide written advice to support verbal advice. For more details, see the RCGP Target toolkit.
• Recognise warning symptoms or a real need for antimicrobials, and refer where appropriate (safety netting). For more details, see the RCGP website for self-care information.

Counselling when dispensing/supplying antimicrobials

Advise the patient to read the patient information leaflet and packaging — as a reminder of key safety messages.

Discuss with them:

• The medicine: what it is, how it works, and how to use it (adherence).
• The condition: ask if they understand their infection, e.g. what they have been told about their infection, and when they have been advised that they should expect to feel better. The RCGP website includes self-care information.
• Importance of adherence: ensure they know to take the medicine at regular intervals, as prescribed (correct dose, at a specified time (before, after or with food), for the right duration and via the correct route) and complete the full course, even if symptoms improve. See our guide on medicines adherence for more advice for patients.
• Side/adverse effects: ensure they know which signs and symptoms to watch for and when to seek medical advice and attention.
• Referrals and safety netting: check that they know what to do if symptoms get worse and when to seek further help.
• Interactions: has the patient checked with a pharmacist about possible interactions before starting any new medicines (including prescribed, OTC, herbal products, complementary, vitamins, dietary supplements, recreational drugs, alcohol and tobacco)?
• Offer advice on self-limiting conditions and self-care: see the section on advising on self-limiting conditions and self-care.
• Storage: never keep leftover antimicrobials as a future preventative measure.
• Never share medicines with family or friends.
• Highlight and signpost to further advice and provide written resources.
• Disposal: advise the person to return any unused medicines to a pharmacy for disposal. Explain the potential impact on the environment if disposed at home, e.g. by flushing down the toilet/sink.

For further information on counselling and when to refer, see the BNF, individual product SPC and our guide on counselling patients on the use of medicines.

You may wish to keep records of prescribing or advice given. Visit our guide on clinical documentation.

Providing written resources and signposting people to further advice

Training and education for pharmacy teams

A range of educational resources and signposting to help you develop the knowledge, skills and confidence to lead AMS interventions, benefiting you, your workplace and your patients.

National organisations and royal colleges can also offer relevant education and training resources.

Why not enrol on postgraduate courses, such as diplomas or masters, or study for a PhD in AMS-relevant fields? Further information can be found on individual university websites.

Further information

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