Objective 4: Antimicrobial stewardship

Objective 4 of the NZ Antimicrobial Resistance Action Plan is to optimise the use of antimicrobial medicines in human health, animal health and agriculture, including by maintaining and enhancing the regulation of animal and agriculture antimicrobials.

Priority action area 12

Develop a national programme or standard for AMS in all sectors of human health, including resources and/or targets for use in all sectors.

Activity
Ongoing activities
1. Continue to consider antimicrobial stewardship under PHARMAC’s Factors for Consideration in antimicrobial funding decisions and continue to consult with relevant stakeholders when considering funding of antimicrobial agents.
2. Continue to regularly provide data on how various prescriber types contribute to community antimicrobial consumption, to help improve community prescribing (see also Priority action areas 3 and 4, activity 3).
3. Continue work to develop regional (Northern, Midland, Central and Southern) antimicrobial treatment guidance and then consider developing national antimicrobial treatment guidance.
Activity
Year 1 activities
4. Investigate any inequities in antimicrobial prescribing in community and hospital settings.
5. Consider options and resource requirements for increasing access to antimicrobial treatment and stewardship guidance; for example, by using applications for mobile devices (in line with Priority action area 2, activity 3).
6. Consider options to improve access to antimicrobial stewardship services, advice and support in hospitals and communities.
7. Encourage hospitals and aged residential care facilities to use a standardised system, for example: Australian Commission on Quality and Safety in Health Care 2016 for measuring the appropriateness of their antimicrobial consumption.
8. Contribute to the review of the infection prevention and control component of the Health and Disability Services Standards (Standards New Zealand 2008) as they relate to antimicrobial stewardship.
Activity
Years 2–5 activities
9. Based on information from Priority action area 12, activities 2 and 4, consider and, if appropriate, implement relevant national benchmarks for the short (one-year) and medium (three-year) term on reducing antimicrobial consumption and increasing appropriate prescribing.
10. Develop national antimicrobial treatment guidance, as appropriate, and implement initiatives to increase access to antimicrobial treatment guidance (in line with Priority action area 12, activities 3 and 5).
11. Provide support for all hospitals and aged residential care facilities to use a standardised system for measuring the appropriateness of antimicrobial consumption (see also Priority action area 12, activities 7 and 9).
12. Review and establish mechanisms to feed back overviews, benchmarking reports and analysed data on antimicrobial dispensing to all prescribers and antimicrobial stewardship teams (see also Priority action areas 3 and 4, activity 3).
13. Implement initiatives identified in Priority action area 6, activity 12 to ensure that antimicrobial stewardship services, advice and support are accessible both in hospitals and in the community.

Priority action area 13

Develop a national programme or standard for AMS in animal health.

Activity
Year 1 activities
1. Develop a prudent use directive document for antimicrobials that set expectations for the regulator and the diverse range of sectors within primary industries that can be used to develop specific prudent use guidance documents for their sector.
2. Update current industry judicious use guidelines drawing on information from the current surveillance programme (in line with Priority action areas 3 and 4, activities 9–10).
Activity
Years 2–5 activities
3. Use available surveillance information (in line with Priority action areas 3 and 4, activity 15) to identify the drivers of antimicrobial stewardship and develop a national programme for antimicrobial stewardship in animal health.
4. Review the Veterinary Council of New Zealand’s veterinary medicines section of the Code of Professional Conduct to include a new section on prescribing and dispensing of antibiotics.

Priority action area 14

Establish a programme of regularly monitoring the controls on antimicrobial veterinary medicines.

Activity
Year 1 activities
1. Establish an ongoing reassessment programme for antimicrobials used in veterinary medicine.
Activity
Years 2–5 activities
2. Develop a regular monitoring programme of veterinary authorisation of antibiotics.

Priority action area 15

Review the controls (conditions of registration), labelling and advertising of antimicrobial-based trade name products to ensure they are fit for purpose.

Activity
Ongoing activities
1. Review the appropriateness of the regulations that limit pharmaceutical advertising (including direct to consumer and to health care professionals) of human health antimicrobial agents and, as needed, put forward amendments to them.
Activity
Year 1 activities
2. Review guidance information for those applying to register antimicrobials to ensure it is appropriate for determining the level of regulatory oversight of human health, animal health and agricultural antimicrobials, and update it as necessary.
3. Review the current controls and labelling on human health, animal health and agricultural antimicrobials to ensure they are appropriate to manage antimicrobial resistance, and update them as necessary.
Activity
Years 2–5 activities
4. Review any changes to guidance information, controls and labelling of human health, animal health and agricultural antimicrobials to identify their impact.
5. Review approval processes for registering human health antimicrobials.
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