Implementation of the national antimicrobial stewardship competencies for UK undergraduate healthcare professional education within undergraduate pharmacy programmes: a survey of UK schools of pharmacy.

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.

Teacher and Student Views on the Feasibility of Peer to Peer Education as a Model to Educate 16-18 Year Olds on Prudent Antibiotic Use-A Qualitative Study.

Peer education (PE) has been used successfully to improve young peoples' health-related behaviour. This paper describes a qualitative evaluation of the feasibility of university healthcare students delivering PE, covering self-care and antibiotic use for infections, to biology students in three UK schools (16-18 years), who then educated their peers. Twenty peer educators (PEds) participated in focus groups and two teachers took part in interviews to discuss PE feasibility. Data were analysed inductively. All participants reported that teaching students about antibiotic resistance was important. PE was used by PEds to gain communication skills and experience for their CV. PEds confidence increased with practice and group delivery. Interactive activities and real-life illness scenarios facilitated enjoyment. Barriers to PE were competing school priorities, no antibiotic content in the non-biology curriculum, controlling disruptive behaviour, and evaluation consent and questionnaire completion. Participation increased PEds' awareness of appropriate antibiotic use. This qualitative study supports the feasibility of delivering PE in schools. Maximising interactive and illness scenario content, greater training and support for PEds, and inclusion of infection self-care and antibiotics in the national curriculum for all 16-18-year olds could help facilitate greater antibiotic education in schools. Simplifying consent and data collection procedures would facilitate future evaluations.

Peer-Education as a Tool to Educate on Antibiotics, Resistance and Use in 16-18-Year-Olds: A Feasibility Study.

Peer education (PE) interventions may help improve knowledge and appropriate use of antibiotics in young adults. In this feasibility study, health-care students were trained to educate 16-18 years old biology students, who then educated their non-biology peers, using e-Bug antibiotic lessons. Knowledge was assessed by questionnaires, and antibiotic use by questionnaire, SMS messaging and GP record searches. Five of 17 schools approached participated (3 PE and 2 control (usual lessons)). 59% (10/17) of university students and 28% (15/54) of biology students volunteered as peer-educators. PE was well-received; 30% (38/127) intervention students and 55% (66/120) control students completed all questionnaires. Antibiotic use from GP medical records (54/136, 40% of students' data available), student SMS (69/136, 51% replied) and questionnaire (109/136, 80% completed) data showed good agreement between GP and SMS (kappa = 0.72), but poor agreement between GP and questionnaires (kappa = 0.06). Median knowledge scores were higher post-intervention, with greater improvement for non-biology students. Delivering and evaluating e-Bug PE is feasible with supportive school staff. Single tiered PE by university students may be easier to regulate and manage due to time constraints on school students. SMS collection of antibiotic data is easier and has similar accuracy to GP data.

Antibiotic resistance awareness: a public engagement approach for all pharmacists.

OBJECTIVES: The main objective of this study was to promote knowledge about antibiotic resistance development and good stewardship principles amongst the general population through pharmacy student-led public engagement workshops in high schools. METHODS: Structured questionnaires, based on the Key Stage 4 curriculum were initially used to assess awareness and knowledge of antibiotic resistance issues amongst year 10 and 11 (GCSE stage) high school pupils. A Prezi-style presentation (https://prezi.com/) was subsequently developed to deliver a positive message that the young learners could share with friends and family. KEY FINDINGS: Misconceptions still exist regarding the correct and appropriate use of antibiotics. The person-person approach adopted by this study was well received, key antibiotic stewardship messages being delivered to the general population through either educational surveys or hands-on workshops. CONCLUSIONS: It is widely acknowledged that antibiotic resistance is one of the biggest threats facing society today. As healthcare professionals, pharmacists in all sectors have a crucial role to play in educating the public about antibiotics and how to use them effectively. This article describes the different ways by which all pharmacists can help educate the public on key issues, with particular emphasis on the next generation.

Enhancement of the properties of a drug by mono-deuteriation: reduction of acid-catalysed formation of a gut-motilide enol ether from 8-deuterio-erythromycin B.

Erythromycin B is structurally very similar to erythromycin A, and also shares its clinically important antibacterial activity. Its potential advantage is that it is much more stable to acid. Both compounds are susceptible to 6-9-enol ether formation, involving loss of a proton from C-8. The enol ethers lack antibacterial activity and can give rise to unpleasant gut motilide side-effects. Our previous work on degradation kinetics revealed that the formation of erythromycin B enol ether from erythromycin B is subject to a large deuterium isotope effect. We therefore synthesized 8-d-erythromycin B (in 87% yield) in the hope that acid-catalysed enol ether formation would be reduced, relative to erythromycin B. In a range of microbiological and biochemical assays, deuteriation did not appear to compromise the efficacy of the drug. Degradation studies showed, however, that incorporation of deuterium into erythromycin B reduces (though does not completely suppress) enol ether formation, providing the possibility of using a facile mono-deuteriation to reduce the gut motilide side-effects of the drug.

Influence of gentamicin and tobramycin on binary biofilm formation by co-cultures of Burkholderia cepacia and Pseudomonas aeruginosa.

The aim of this study was to investigate the stability and dynamics of binary culture biofilm formation following antibiotic treatment. Pseudo steady-state biofilm cultures of clinical strains of P. aeruginosa and B. cepacia concurrently isolated from a single CF patient were established in separate Constant Depth Film Fermenters (CDFFs). Pans, containing established biofilms, were swapped between CDFFs. Biofilms were treated either for 5 days with tobramycin (0.3 mg/ml) prior to pan-swapping, or with gentamicin (1 mg/ml) immediately following pan-swapping. In both instances stable binary biofilms were formed. In addition, fresh un-colonised surfaces added at the time of pan-swapping and exposed simultaneously to biofilm derived P. aeruginosa and B. cepacia and subjected to antibiotic challenge also established stable binary communities. Treatment of P. aeruginosa and B. cepacia with tobramycin or gentamicin, either prior to or immediately after surface colonisation had little effect on the establishment of stable binary biofilms. Such treatment also had little effect on the immigration of one organism into an established biofilm of a second organism.

Biofilms, homoserine lactones and biocide susceptibility.

AIMS: To investigate the susceptibility, to a range of different biocides, of Pseudomonas aeruginosa strains variously deficient in N-acyl homoserine lactone systems, grown either as planktonic or biofilm populations. METHODS AND RESULTS: Biocide susceptibility data were generated for strains of P. aeruginosa deficient in N-acyl homoserine lactone production, grown planktonically or as biofilm populations using a poloxamer hydrogel construct. Component cells from the biofilm constructs were also tested for their susceptibility. Significant differences in susceptibility were noted between the wild-type strain, a mutant defective in the long chain (C-12) homoserine lactone and a mutant defective in the short chain (C-4) homoserine lactone which could not be related to the biofilm mode of growth. Moreover, differences in susceptibility appeared to be dependent upon the nature of the homoserine lactone deletion and type of biocide rather than the mode of growth. CONCLUSIONS: No general trend exists between homoserine lactone deficiency and biocide susceptibility regardless of mode of growth.

The biofilm matrix.

The extracellular matrix is a complex and extremely important component of all biofilms, providing architectural structure and mechanical stability to the attached population. The matrix is composed of cells, water and secreted/released extracellular macromolecules. In addition, a range of enzymic and regulatory activities can be found within the matrix. Together, these different components and activities are likely to interact and in so doing create a series of local environments within the matrix which co-exist as a functional consortium. The matrix architecture is also subject to a number of extrinsic factors, including fluctuations in nutrient and gaseous levels and fluid shear. Together, these intrinsic and extrinsic factors combine to produce a dynamic, heterogeneous microenvironment for the attached and enveloped cells.