Table Of Content

NICE Medicines and prescribing centre DRAFT for consultation Antimicrobial stewardship Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use Medicines practice guideline Appendices February 2015 Draft for consultation 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 attendees ............................. 17 Appendix B: Scope ............................................................................................................. 21 Appendix C: How this guideline was developed............................................................... 27 C.1 Search strategies for the guideline ..................................................................... 27 C.1.1 Scoping searches .................................................................................. 27 C.1.2 Main searches ........................................................................................ 29 C.1.3 Economic evaluations and quality of life data ..................................... 38 C.2 Review questions and review protocols ............................................................. 42 C.2.1 Reducing antimicrobial resistance........................................................ 42 C.2.2 Decision making ..................................................................................... 45 C.2.3 Barriers to decision making ................................................................... 49 C.2.4 Timely adoption and diffusion of a new antimicrobial ......................... 51 C.3 Clinical consort diagrams ..................................................................................... 54 C.3.1 Reducing antimicrobial resistance........................................................ 54 C.3.2 Decision making ..................................................................................... 55 C.3.3 Barriers to decision making ................................................................... 56 C.3.4 Timely adoption and diffusion of a new antimicrobial ......................... 56 C.4 Economic consort diagrams ................................................................................ 57 C.4.1 Reducing antimicrobial resistance........................................................ 57 C.4.2 Decision making ..................................................................................... 57 C.4.3 Barriers to decision making ................................................................... 57 C.4.4 Timely adoption and diffusion of a new antimicrobial ......................... 57 C.5 Clinical excluded studies...................................................................................... 58 C.5.1 Reducing antimicrobial resistance........................................................ 58 C.5.2 Decision making ..................................................................................... 76 C.5.3 Barriers to decision making ................................................................... 92 C.5.4 Timely adoption and diffusion of a new antimicrobial ......................... 99 C.6 Economic excluded studies ................................................................................. 99 C.6.1 Reducing antimicrobial resistance........................................................ 99 C.6.2 Decision making ..................................................................................... 99 C.6.3 Barriers to decision making ................................................................. 100 C.6.4 Timely adoption and diffusion of a new antimicrobial ....................... 100 Appendix D: Clinical evidence tables and GRADE profiles ........................................... 101 D.1 Evidence tables .................................................................................................. 101 D.1.1 Reducing antimicrobial resistance...................................................... 101 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) ..................................................................................... 126 D.1.3 Decision making ................................................................................... 132 D.1.4 Barriers to decision making ................................................................. 170 D.1.5 Timely adoption and diffusion of a new antimicrobial ....................... 182 D.2 GRADE profiles and forest plots ....................................................................... 184 D.2.1 Reducing antimicrobial resistance...................................................... 184 D.2.2 Decision making ................................................................................... 205 D.2.3 Barriers to decision making ................................................................. 211 D.2.4 Timely adoption and diffusion of a new antimicrobial ....................... 212 Appendix E: Economic evidence tables .......................................................................... 214 E.1 Reducing antimicrobial resistance. ................................................................... 214 E.2 Decision making ................................................................................................. 214 E.3 Barriers to decision making ............................................................................... 215 E.4 Timely adoption and diffusion of a new antimicrobial ...................................... 215 Appendix F: Linking evidence to recommendations ...................................................... 216 Appendix G: Organisations providing written or oral evidence ..................................... 218 Appendix H: Quality assessment checklist ..................................................................... 220 National Institute for Health and Care Excellence 2015 4 Appendices Declarations 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. 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) Second GDG meeting (8 No changes to record None September 2014) National Institute for Health and Care Excellence 2015 5 Appendices Declarations of interest GDG meeting Declaration of interest Action taken Third GDG meeting (30 No changes to record None September 2014) Fourth GDG meeting (14 No changes to record None November 2014) 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) 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 to the guideline may lead to a conflict of interest. Emailed 31 July 2014 Published author on research into antimicrobial Chair and Project lead will monitor for any potential conflict. stewardship interventions and behaviour change in this Also discussed with the Nice Medicines and prescribing field including Cochrane reviews (one ongoing at centre Programme Director. present). Has also published research on use of mobile Advice given regards ensuring that information learnt as health technology to deliver antimicrobial stewardship part of the NICE guideline process is not shared with other committees/groups or included within any written articles. National Institute for Health and Care Excellence 2015 6 Appendices Declarations of interest GDG meeting Declaration of interest Action taken interventions. Salary is funded by the National Institute of Health Research on a grant investigating behaviour change in antimicrobial prescribing. Honorary visiting researcher to Haukeland University in Norway where advice on the implementation of the national implementation of an antimicrobial stewardship programme. 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 Undertaking research at PhD level into antibiotic Chair and Project lead will monitor for any potential conflict. November 2014) prescribing behaviours in secondary care. Advice given regards ensuring that information learnt as part of the NICE guideline process is not shared with other Published author in the field of antibiotic prescribing committees/groups or included within any written articles. behaviours and antimicrobial stewardship. Lynne Craven 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) National Institute for Health and Care Excellence 2015 7 Appendices Declarations of interest Martin Duerden GDG meeting Declaration of interest Action taken Recruitment Received personal payment (honoraria) plus Advice given regards ensuring that information learnt as reimbursement of expenses from Reckitt Benckiser (RB) part of the NICE guideline process is not shared with other to speak at 2 meetings in the last 12 months. The subject committees/groups or included within any written articles. of the talks was antibiotic use in respiratory infections at each meeting but there was no promotion of products Advised not to write for any publication until the guideline marketed by RB in the content. has published. In the last 12 months has also received payment from the publishers of Pulse, GP and Prescriber for writing various articles on prescribing and therapeutics, including antibiotic use. First GDG meeting (3 June Clinical Adviser on Prescribing for the Royal College of None 2014) General Practitioners but does not receive payment for this. Emailed 26 August 2014 Member of the Global Respiratory Infection Partnership Advice given regards ensuring that information learnt as (work declared above with RB done in this capacity). Now part of the NICE guideline process is not shared with other spoken at 4 meetings in the last 12 months. committees/groups or included within any written articles. On the Editorial Board of Drug and Therapeutics Bulletin, a BMJ Group publication, this is a paid position. Advised not to write for any publication until the guideline has published. On the editorial board of Prescriber (a Wiley publication) which is an unpaid position. Occasionally writes opinion based editorials and articles for this publication. Receives payments for these. In the last year was commissioned and co-wrote a report on Polypharmacy for the King’s Fund and received payment for this. Also spoke at a King’s Fund seminar on the topic. I am a member of the Paediatric Formulary Committee for the British National Formulary (BNF) payment not received for this. Second GDG meeting (8 No changes to record None September 2014) Third GDG meeting (30 No changes to record None National Institute for Health and Care Excellence 2015 8 Appendices Declarations of interest GDG meeting Declaration of interest Action taken September 2014) Fourth GDG meeting (14 Recently has received small payments for articles on the Advice given regards ensuring that information learnt as November 2014) Lipid Modification Clinical Guideline from Pulse and from part of the NICE guideline process is not shared with other Guidelines in Practice. committees/groups or included within any written articles. Chair and Project lead will monitor for any potential conflict. Member of the NICE Guideline Development Group on Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. On the Medicines Committee for the Royal College of Paediatrics and Child Health - payment not received for this. Member of the NICE technology appraisals Committee until October 2014. This is not a paid position. Fifth GDG meeting (16 March 2015) Heather Edmonds 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) Rose Gallagher GDG meeting Declaration of interest Action taken Recruitment None None National Institute for Health and Care Excellence 2015 9 Appendices Declarations of interest GDG meeting Declaration of interest Action taken Second GDG meeting (8 Involved in a Royal College of Nursing published position Chair and Project lead will monitor for any potential conflict September 2014) statement which was sponsored by Pfizer. Advice given regards ensuring that information learnt as part of the NICE guideline process is not shared with other committees/groups etc. Third GDG meeting (30 No changes to record None September 2014) Fourth GDG meeting (14 No changes to record None November 2014) Philip Howard GDG meeting Declaration of interest Action taken Recruitment Paid consultancy work on antibiotics for the Advised not to undertake any further consultancy work in pharmaceutical industry i.e. Pfizer (Linezolid), Astellas this area during the development of the guideline through to (Levofloxacin), AstraZeneca (Ceftaroline), Novartis publication. (Daptomycin), Gilead (Ambisome). First GDG meeting (3 June Paid consultancy work with Danone on antimicrobial Advised not to undertake any further consultancy work in 2014) stewardship. this area during the development of the guideline through to publication. Committee member of UK Clinical Pharmacy Association - Pharmacy Infection Network. Advice given regards ensuring that information learnt as Council member of British Infection Association (until May part of the NICE guideline process is not shared with other 2013). committees/groups etc. Council member of British Society of Antimicrobial Chemotherapy. Chair and Project lead will monitor for any potential conflict Represented International Pharmaceutical Federation (FIP) at WHO (World Health Organisation) Antimicrobial Resistance Strategic Technical Advisory Group (May 2014). Published unpaid articles related to AMS. Spokesman on Antimicrobials for Royal Pharmaceutical Society. National Institute for Health and Care Excellence 2015 10

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This guideline represents the views of NICE and was arrived at after careful consideration of the evidence available. part of the NICE guideline process is not shared with other committees/groups etc .. John Morris. GDG meeting.
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NICE Medicines and prescribing centre DRAFT for consultation Antimicrobial stewardship Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use Medicines practice guideline Appendices February 2015 Draft for consultation 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 attendees ............................. 17 Appendix B: Scope ............................................................................................................. 21 Appendix C: How this guideline was developed............................................................... 27 C.1 Search strategies for the guideline ..................................................................... 27 C.1.1 Scoping searches .................................................................................. 27 C.1.2 Main searches ........................................................................................ 29 C.1.3 Economic evaluations and quality of life data ..................................... 38 C.2 Review questions and review protocols ............................................................. 42 C.2.1 Reducing antimicrobial resistance........................................................ 42 C.2.2 Decision making ..................................................................................... 45 C.2.3 Barriers to decision making ................................................................... 49 C.2.4 Timely adoption and diffusion of a new antimicrobial ......................... 51 C.3 Clinical consort diagrams ..................................................................................... 54 C.3.1 Reducing antimicrobial resistance........................................................ 54 C.3.2 Decision making ..................................................................................... 55 C.3.3 Barriers to decision making ................................................................... 56 C.3.4 Timely adoption and diffusion of a new antimicrobial ......................... 56 C.4 Economic consort diagrams ................................................................................ 57 C.4.1 Reducing antimicrobial resistance........................................................ 57 C.4.2 Decision making ..................................................................................... 57 C.4.3 Barriers to decision making ................................................................... 57 C.4.4 Timely adoption and diffusion of a new antimicrobial ......................... 57 C.5 Clinical excluded studies...................................................................................... 58 C.5.1 Reducing antimicrobial resistance........................................................ 58 C.5.2 Decision making ..................................................................................... 76 C.5.3 Barriers to decision making ................................................................... 92 C.5.4 Timely adoption and diffusion of a new antimicrobial ......................... 99 C.6 Economic excluded studies ................................................................................. 99 C.6.1 Reducing antimicrobial resistance........................................................ 99 C.6.2 Decision making ..................................................................................... 99 C.6.3 Barriers to decision making ................................................................. 100 C.6.4 Timely adoption and diffusion of a new antimicrobial ....................... 100 Appendix D: Clinical evidence tables and GRADE profiles ........................................... 101 D.1 Evidence tables .................................................................................................. 101 D.1.1 Reducing antimicrobial resistance...................................................... 101 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) ..................................................................................... 126 D.1.3 Decision making ................................................................................... 132 D.1.4 Barriers to decision making ................................................................. 170 D.1.5 Timely adoption and diffusion of a new antimicrobial ....................... 182 D.2 GRADE profiles and forest plots ....................................................................... 184 D.2.1 Reducing antimicrobial resistance...................................................... 184 D.2.2 Decision making ................................................................................... 205 D.2.3 Barriers to decision making ................................................................. 211 D.2.4 Timely adoption and diffusion of a new antimicrobial ....................... 212 Appendix E: Economic evidence tables .......................................................................... 214 E.1 Reducing antimicrobial resistance. ................................................................... 214 E.2 Decision making ................................................................................................. 214 E.3 Barriers to decision making ............................................................................... 215 E.4 Timely adoption and diffusion of a new antimicrobial ...................................... 215 Appendix F: Linking evidence to recommendations ...................................................... 216 Appendix G: Organisations providing written or oral evidence ..................................... 218 Appendix H: Quality assessment checklist ..................................................................... 220 National Institute for Health and Care Excellence 2015 4 Appendices Declarations 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. 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) Second GDG meeting (8 No changes to record None September 2014) National Institute for Health and Care Excellence 2015 5 Appendices Declarations of interest GDG meeting Declaration of interest Action taken Third GDG meeting (30 No changes to record None September 2014) Fourth GDG meeting (14 No changes to record None November 2014) 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) 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 to the guideline may lead to a conflict of interest. Emailed 31 July 2014 Published author on research into antimicrobial Chair and Project lead will monitor for any potential conflict. stewardship interventions and behaviour change in this Also discussed with the Nice Medicines and prescribing field including Cochrane reviews (one ongoing at centre Programme Director. present). Has also published research on use of mobile Advice given regards ensuring that information learnt as health technology to deliver antimicrobial stewardship part of the NICE guideline process is not shared with other committees/groups or included within any written articles. National Institute for Health and Care Excellence 2015 6 Appendices Declarations of interest GDG meeting Declaration of interest Action taken interventions. Salary is funded by the National Institute of Health Research on a grant investigating behaviour change in antimicrobial prescribing. Honorary visiting researcher to Haukeland University in Norway where advice on the implementation of the national implementation of an antimicrobial stewardship programme. 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 Undertaking research at PhD level into antibiotic Chair and Project lead will monitor for any potential conflict. November 2014) prescribing behaviours in secondary care. Advice given regards ensuring that information learnt as part of the NICE guideline process is not shared with other Published author in the field of antibiotic prescribing committees/groups or included within any written articles. behaviours and antimicrobial stewardship. Lynne Craven 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) National Institute for Health and Care Excellence 2015 7 Appendices Declarations of interest Martin Duerden GDG meeting Declaration of interest Action taken Recruitment Received personal payment (honoraria) plus Advice given regards ensuring that information learnt as reimbursement of expenses from Reckitt Benckiser (RB) part of the NICE guideline process is not shared with other to speak at 2 meetings in the last 12 months. The subject committees/groups or included within any written articles. of the talks was antibiotic use in respiratory infections at each meeting but there was no promotion of products Advised not to write for any publication until the guideline marketed by RB in the content. has published. In the last 12 months has also received payment from the publishers of Pulse, GP and Prescriber for writing various articles on prescribing and therapeutics, including antibiotic use. First GDG meeting (3 June Clinical Adviser on Prescribing for the Royal College of None 2014) General Practitioners but does not receive payment for this. Emailed 26 August 2014 Member of the Global Respiratory Infection Partnership Advice given regards ensuring that information learnt as (work declared above with RB done in this capacity). Now part of the NICE guideline process is not shared with other spoken at 4 meetings in the last 12 months. committees/groups or included within any written articles. On the Editorial Board of Drug and Therapeutics Bulletin, a BMJ Group publication, this is a paid position. Advised not to write for any publication until the guideline has published. On the editorial board of Prescriber (a Wiley publication) which is an unpaid position. Occasionally writes opinion based editorials and articles for this publication. Receives payments for these. In the last year was commissioned and co-wrote a report on Polypharmacy for the King’s Fund and received payment for this. Also spoke at a King’s Fund seminar on the topic. I am a member of the Paediatric Formulary Committee for the British National Formulary (BNF) payment not received for this. Second GDG meeting (8 No changes to record None September 2014) Third GDG meeting (30 No changes to record None National Institute for Health and Care Excellence 2015 8 Appendices Declarations of interest GDG meeting Declaration of interest Action taken September 2014) Fourth GDG meeting (14 Recently has received small payments for articles on the Advice given regards ensuring that information learnt as November 2014) Lipid Modification Clinical Guideline from Pulse and from part of the NICE guideline process is not shared with other Guidelines in Practice. committees/groups or included within any written articles. Chair and Project lead will monitor for any potential conflict. Member of the NICE Guideline Development Group on Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. On the Medicines Committee for the Royal College of Paediatrics and Child Health - payment not received for this. Member of the NICE technology appraisals Committee until October 2014. This is not a paid position. Fifth GDG meeting (16 March 2015) Heather Edmonds 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) Rose Gallagher GDG meeting Declaration of interest Action taken Recruitment None None National Institute for Health and Care Excellence 2015 9 Appendices Declarations of interest GDG meeting Declaration of interest Action taken Second GDG meeting (8 Involved in a Royal College of Nursing published position Chair and Project lead will monitor for any potential conflict September 2014) statement which was sponsored by Pfizer. Advice given regards ensuring that information learnt as part of the NICE guideline process is not shared with other committees/groups etc. Third GDG meeting (30 No changes to record None September 2014) Fourth GDG meeting (14 No changes to record None November 2014) Philip Howard GDG meeting Declaration of interest Action taken Recruitment Paid consultancy work on antibiotics for the Advised not to undertake any further consultancy work in pharmaceutical industry i.e. Pfizer (Linezolid), Astellas this area during the development of the guideline through to (Levofloxacin), AstraZeneca (Ceftaroline), Novartis publication. (Daptomycin), Gilead (Ambisome). First GDG meeting (3 June Paid consultancy work with Danone on antimicrobial Advised not to undertake any further consultancy work in 2014) stewardship. this area during the development of the guideline through to publication. Committee member of UK Clinical Pharmacy Association - Pharmacy Infection Network. Advice given regards ensuring that information learnt as Council member of British Infection Association (until May part of the NICE guideline process is not shared with other 2013). committees/groups etc. Council member of British Society of Antimicrobial Chemotherapy. Chair and Project lead will monitor for any potential conflict Represented International Pharmaceutical Federation (FIP) at WHO (World Health Organisation) Antimicrobial Resistance Strategic Technical Advisory Group (May 2014). Published unpaid articles related to AMS. Spokesman on Antimicrobials for Royal Pharmaceutical Society. National Institute for Health and Care Excellence 2015 10

Description:
This guideline represents the views of NICE and was arrived at after careful consideration of the evidence available. part of the NICE guideline process is not shared with other committees/groups etc .. John Morris. GDG meeting.
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