Antibiotics are one of the most widely prescribed group of drugs in the UK. However, their widespread use has resulted in antibiotic resistance and unnecessary prescribing. This article provides an overview of antibiotic therapy, including the principles and modes of action of drug treatment, prescribing criteria and the issue of antibiotic resistance.

BackgroundUpdated European Committee on Antimicrobial Susceptibility Testing (EUCAST) amikacin breakpoints for Enterobacterales and Pseudomonas aeruginosa included revised dosing recommendations of 25–30 mg/kg to achieve key pharmacokinetic/pharmacodynamic parameters, higher than recommended in the British National Formulary. The objectives of this review were to identify clinical evidence for high-dose amikacin regimens and to determine drug exposures that are related to adverse events and toxicity.MethodsThe literature search was conducted in October 2021 and updated in May 2022 using electronic databases for any study reporting adult participants treated with amikacin at doses ≥20 mg/kg/day. Reference lists of included papers were also screened for potential papers. Data were extracted for pharmacokinetic parameters and clinical outcomes, presented in a summary table and consolidated narratively. Meta-analysis was not possible. Each study was assessed for bias before, during and after the intervention using the ROBINS-I tool.ResultsNine studies (total 501 participants in 10 reports) were identified and included, eight of which were observational studies. Assessment of bias showed substantial flaws. Dosing regimens ranged from 25 to 30 mg/kg/day. Six studies adjusted the dose in obesity when participants had a body mass index of ≥30 kg/m2. Target peak serum concentrations ranged from 60 mg/L to 80 mg/L and 59.6–81.8% of patients achieved these targets, but there was no information on clinical outcomes. Two studies reported the impact of high-dose amikacin on renal function. No studies reporting auditory or vestibular toxicity were identified.ConclusionAll included papers were limited by a significant risk of bias, while methodological and reporting heterogeneity made drawing conclusions challenging. Lack of information on the impact on renal function or ototoxicity means high-dose regimens should be used cautiously in older people. There is a need for a consensus guideline for high-dose amikacin to be written.Trial registration numberPROSPERO (CRD42021250022).

Introduction The United Kingdom Clinical Pharmacist Association Pharmacy Infection Network (UKCPA PIN) is the community of pharmacy professionals with an interest or specialism in infection management. As we come out of the Covid-19 pandemic, it is important for the leadership of UKCPA PIN to understand the current need and wishes of the community. Aim This study aimed to explore infection specialist pharmacy professionals about their research activity, experience, and perceived barriers to greater research activity. Methods An online, anonymised survey, consisting of closed and free-type open questions, was circulated to UKCPA PIN members for completion in September and October 2021 using the Google Forms platform. The questionnaire was developed and piloted amongst members of UKCPA PIN committee to identify current research activity and barriers. Responses were downloaded and underwent descriptive analysis with Microsoft Excel. This work was deemed a service evaluation and therefore did not require ethics approval. Results There were 38 responses were received from pharmacists in all 7 NHS England regions, Scotland, and Wales (6% of UKCPA PIN forum members). Pharmacy technicians were invited to participate but none did so. 13 (34%) described themselves as being actively involved in research, 13 (34%) described themselves as having done research in the past, 8 (21%) described themselves as not having the opportunity to develop research capabilities. 27 (71%) respondents had completed a postgraduate diploma, 8 (21%) had completed MSc or equivalent, 6 (16%) had completed a PhD or equivalent, 11 (29%) were Good Clinical Practice accredited and 10 (26%) had undertaken local research training. 6 (16%) were consultant pharmacists or accredited by the Royal Pharmaceutical Society as being consultant-ready, 10 (27%) were building a consultant portfolio and 15 (39%) were aspiring to build a consultant portfolio in the future. Of the 28% that were building a consultant portfolio, 6 were confident that they were already meeting the research outcomes and 4 were not. Antimicrobial pharmacists were most frequently wanting to undertake research in the areas of antimicrobial stewardship (11, 29%), antifungal stewardship (5, 13%) and allergies/penicillin delabelling (5, 13%). The greatest barriers identified were lack of time/funding (27, 71% agreed significant barrier), lack of funding for costs of undertaking research (17, 45%), lack of support with research methods (9, 24%) and lack of support with dissemination of research (9, 24%). A number of potential support options were proposed to respondents, with “Signposting resources to help you write research protocols” and “A repository of in progress antimicrobial research in the UK” being the most popular (19 and 17 respondents, respectively, described as very useful). Discussion/Conclusion There is a significant interest in research amongst antimicrobial pharmacists and scope for enhancing the contribution of pharmacists to research around antimicrobials and infectious disease. A limitation of this study was the small sample size; however, the themes provide important information for UKCPA PIN to provide support for its members.

Background Pharmacists play a key role in antimicrobial stewardship (AMS). Consensus-based national AMS competencies for undergraduate healthcare professionals in the UK reflect the increasing emphasis on competency-based healthcare professional education. However, the extent to which these are included within undergraduate pharmacy education programmes in the UK is unknown. Objectives To explore which of the AMS competencies are delivered, including when and at which level, within UK undergraduate MPharm programmes. Methods A cross-sectional online questionnaire captured the level of study of the MPharm programme in which each competency was taught, the method of delivery and assessment of AMS education, and examples of student feedback. Results Ten institutions completed the survey (33% response rate). No institution reported covering all 54 AMS competencies and 5 of these were taught at half or fewer of the institutions. Key gaps were identified around taking samples, communication, outpatient parenteral antimicrobial therapy and surgical prophylaxis. The minimum time dedicated to AMS teaching differed between institutions (range 9–119 h), teaching was generally through didactic methods, and assessment was generally through knowledge recall and objective structured clinical examinations. Feedback from students suggests they find AMS and antimicrobial resistance (AMR) to be complex yet important topics. Conclusions UK schools of pharmacy should utilize the competency framework to identify gaps in their AMS, AMR and infection teaching. To prepare newly qualified pharmacists to be effective at delivering AMS and prescribing antimicrobials, schools of pharmacy should utilize more simulated environments and clinical placements for education and assessment of AMS.

Background Amikacin is an aminoglycoside with activity against Gram negative pathogens. Updated EUCAST amikacin breakpoints for Enterobacterales and Pseudomonas aeruginosa included revised dosing recommendations of 25-30mg/kg to achieve key pharmacokinetic/pharmacodynamic parameters, higher than recommended in the British National Formulary. We undertook a literature review to report preferred dosing regimens, monitoring and toxicities associated with the use of amikacin at doses ≥20mg/kg/day. Methods This literature search was conducted in electronic databases for any study reporting adult participants treated with amikacin at doses ≥20mg/kg/day. Data were extracted for pharmacokinetic parameters and clinical outcomes, while papers were assessed for bias using the ROBINS-I tool. Results Nine papers were identified and included, eight of which were observational studies; assessment of bias showed substantial flaws. Dosing regimens ranged from 25-30mg/kg/day. Six studies adjusted the dose in obesity when participants BMI ≥30 kg/m2. Target peak serum concentrations ranged from 60mg/L-80mg/L and 59.6-81.8% of patients achieved these targets. Two studies reported the impact of high dose amikacin on renal function. No studies reporting auditory or vestibular toxicity were identified. Conclusions Dosing amikacin at 25-30mg/kg achieved peak concentration targets in the majority of patients, but there was no information on clinical outcomes. There is little information about the impact on renal function or ototoxicity; caution with use of high dose regimens in older patients for prolonged periods is recommended. Given the paucity of information, there is a need for a consensus guideline for high dose amikacin or a prospective study.