Introduction

‘Protected’ (alert) antimicrobials are for restricted use only under the authorisation of a Medical Microbiologist, or Infectious Diseases (or other relevant) specialist, and/or according to approved indications within local guidelines/policies.

Their use is restricted for two reasons:

• to slow the development of resistance to an antimicrobial by limiting its use
• there are suitable alternatives that are more cost effective or less toxic

Antimicrobial  resistance is recognised in Scotland and globally as a major threat to public health.  Using narrower-spectrum antibiotics that are less likely to select for resistance is a recognised strategy to limit the emergence of resistant organisms.  The World Health Organisation categorises antibiotics into 3 groups: Access, Watch and Reserve.  The Scottish Antimicrobial Prescribing Group recommend that it is good practice for NHS boards to agree and implement a protected list of WHO Reserve antibiotics. The Antimicrobial Management Team maintain the list of protected (or ‘alert’) antibiotics for NHS Grampian. 

• Prescribers must check that the protected (alert) antimicrobial is being prescribed for an approved indication or has been authorised by an approved specialist and document this in the patient’s medical notes.
• Any member of clinical staff can request that the medical team review and discuss with ID or Microbiology if a protected (alert) antibiotic is not prescribed in line with the guidance.
• This guidance applies to adults and children, but inclusion of antibiotics within this guidance does not imply that the indication is licensed for children.
• Patients in the Infection Unit, Intensive Care Unit and Neonatal Unit are excluded from these restrictions as these patients are reviewed on a regular basis by an infection specialist.
• Any off-label/unlicensed use of an antimicrobial should be under the guidance of an infection specialist, microbiologist or other consultant specialist and standard non-formulary procedures followed.
• Primary Care - The specialist who initiates the alert antimicrobial retains responsibility for assessing clinical efficacy and safety (e.g. monitoring blood results when required). It is important that the details of the authorising specialist, the indication and either a stop/review date or duration should be clearly communicated to the GP and further details provided where necessary.