6 Steps

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Course overview
Tutor bios
Target audience
What is expected of you
Online netiquette

This online course aims to provide training that will increase participants’ knowledge of good antimicrobial stewardship practices. The course will focus on inpatient use of antibiotics.

The specific objective of the course is to help you develop competencies relevant to antibiotic prescribing and the management of antimicrobial resistance in the inpatient neonatal and paediatric setting. The competencies are loosely based on the UK Department of Health’s Antimicrobial prescribing and stewardship competencies (www.gov.uk/government/publications/antimicrobial-prescribing-and-stewardship-competencies)(Department of Health and Public Health England, 2013) and include:

  • Antibiotic modes of action and uses
  • Antibiotic resistance mechanisms
  • Prescribing antibiotics for infections caused by susceptible and resistant organisms
  • Antimicrobial stewardship
  • Monitoring and surveillance
     

Course structure
The course is divided into six modules as follows:

  • Module 1: Key antibiotics/antibiotic groups: What do they do?
  • Module 2: History of antibiotic development and PK/PD basics
  • Module 3: Clinical microbiology: What you need to know to become a better antibiotic prescriber
  • Module 4: MRSA, PRSP, ESBL E. coli: The key players in antimicrobial resistance
  • Module 5: Antimicrobial stewardship: Measures to help providers prescribe antibiotics better
  • Module 6: Antimicrobial resistance goes from local to global 
     

The authors:
Module 1: David Pace, Giangiacomo Nicolini, Stefania Vergnano
Module 2: Irja Lutsar, Charlotte Barker, Jodie Lestner, Jana Lass
Module 3: Jim Gray, Laura Folgori, Simon Drysdale
Module 4: Emmanuel Roilides, Stefan Weichert, Elias Iosifidis
Module 5: Ana Brett, Sanjay Patel, Katja Doerholt
​Module 6: Julia Bielicki, Rebecca Lundin

Course director:
Simon Drysdale

Acknowledgments
We would like to thank Natalie Prevatt for reviewing and providing feedback on the course content.

Copyright on your course
In an online course, you may need to look at text, images or other materials. We have designed the course so that the materials we direct you to are available on an external website or reproduced in the online course material. Permission has been granted for us to reproduce all images and other material included in the course materials.

Copyright statement
More generally you may find it useful to remind yourself of the copyright statement below, which applies to the course as a whole.

Course content
All rights, including copyright, in the content of these Web pages are owned or controlled for these purposes by the European Society for Paediatric Infectious Diseases (ESPID).

In accessing these Web pages, you agree that you may only download the content for your own personal non-commercial use.

You are not permitted to copy, broadcast, download, store (in any medium), transmit, show or play in public, adapt or change in any way the content of these Web pages for any other purpose whatsoever without the prior written permission of ESPID.

For rights clearance, please contact the ESPID Administrative Office.

User contributions
The copyright for all original user contributions within this course (including but not limited to forum posts) remains with the contributor.

You are not permitted to copy, broadcast, download, store (in any medium), transmit, show or play in public, adapt or change in any way, or for any purpose whatsoever, the contributions of others, without having first obtained prior written permission from the individuals concerned.

Simon Drysdale, FRCPCH, PhD: "I qualified from St George’s Hospital Medical School, London in 2003 and undertook a PhD at King’s College London from 2008-2011. I have undertaken training in paediatric infectious diseases in London and Oxford and am currently a consultant and honorary senior lecturer in paediatric infectious diseases at St George’s University Hospital NHS Foundation Trust, London. I have a great interest in antimicrobial stewardship (AMS), currently being the lead for paediatric AMS at St George's, having previously developed paediatric AMS programmes at St Mary’s Hospital, London and in Oxford. Being involved in writing and tutoring one of the modules for this course since its conception has given me great pleasure and allowed me to learn from many of the diverse participants on the course.   As of July 2017, I took over as course director.  I hope you enjoy our course!"

Julia Bielicki, MD, MPH: ​"Since completing my paediatric training and a Masters of Public Health degree at the London School of Hygiene and Tropical Medicine, I have worked as a paediatric emergency medicine consultant and PID researcher. I have strong ties with ESPID and was a Young ESPID board representative from 2011 until 2014. Over the last 3 years, I was mainly affiliated with the Antibiotic Resistance and Prescribing in European Children project. This project was an amazing opportunity to meet many clinicians and researchers interested in understanding the impact of antibiotic resistance on the medical care of neonates and children. My research predominantly focuses on developing appropriate surveillance methodology to assess childhood antibiotic use and prescribing in the community and in hospital, and to establish the level of antibiotic resistance affecting children. Working together with all the contributors to the ESPID Online Antibiotic Management Course has been a great inspiration!"

Rebecca Lundin, ScD, MPH: "Hi everyone! My name is Rebecca Lundin and I am an epidemiologist working with the Paediatric European Network for the Treatment of AIDS and Infectious Diseases (PENTA-ID) based outside of Venice, Italy. Prior to becoming involved in paediatric research I studied obesity prevention for my doctoral thesis at the Harvard School of Public Health and worked on study design, implementation, and analysis as Associate Director of Epidemiology at Pfizer. As a methodologist, I am very interested in the collection and analysis of data on antimicrobial resistance, but as a mother I feel the most important aspect of this work is its application to clinical practice. It has been inspiring to work with so many motivated practitioners and researchers on this course!"

Giangiacomo Nicolini: "Hi everybody! My name is Giangiacomo Nicolini, I live in Italy and I am an Infectious Disease specialist.
I worked for several years with adult patients and I was mainly involved in antibiotics, HIV infection, tropical diseases and mother to child transmitted infections; so I approached the world of children and in the last 10 years I worked as paediatrician, mainly dealing with paediatric infectious diseases and especially with the proper use of antibiotics. Since 2010 I was involved in ARPEC and I am very excited about the opportunities that this project has given me!"

Sanjay Patel MA MSc MBBS: "I am a paediatric infectious diseases consultant working at Southampton Children’s Hospital, UK. I champion paediatric antibiotic stewardship activities within my hospital - I introduced regular paediatric antibiotic stewardship ward rounds in 2012 and have subsequently developed regional empirical antibiotic guidelines for Wessex. I developed the first paediatric outpatient parenteral antibiotic therapy (p-OPAT) service in the UK and currently chair the joint British Society of Antimicrobial Chemotherapy / British Paediatric Allergy, Immunology and Infectious Diseases Group p-OPAT national working group which developed good practice guidelines for the introduction and delivery of p-OPAT services in the UK. I am currently a member for the NICE antibiotic stewardship guideline development group and am also involved in setting-up an ESPID paediatric antibiotic stewardship working group, having hosted a working lunch to discuss the implementation of paediatric antibiotic stewardship at ESPID 2014. I spend lots of time thinking about antibiotic stewardship!"

Jodi Lestner MBChB MRes MRCPCH: "Having completing my undergraduate medical studies I began my training as paediatric physician in the UK and I am currently an Academic Clinical Fellow in paediatric infectious disease. Recently I have been involved in the analysis of data gathered from the Antibiotic Resistance and Prescribing in European Children project and also in the planning and coordination of a multi-centre randomised trial investigating optimised vancomycin dosing in neonates across Europe. My research interests include antimicrobial pharmacology and PKPD modelling to inform optimised trial design and dosing of antimicrobials in neonates and children. Working with the ESPID Online Antibiotic Management Course team has been a great experience and I look forward to supporting those who undertaking the course."

Emmanuel Roilides, MD, PhD, FIDSA: "Professor Roilides is Professor of Paediatrics – Infectious Diseases in Aristotle University School of Medicine at Hippokration Hospital in Thessaloniki, Greece. He received his medical and doctor of philosophy degrees from the University of Athens in Greece, and worked for seven years at the National Institutes of Health (Child Health Institute and NCI) in Bethesda, Maryland, USA. Since 1993, Professor Roilides has been a faculty member in the Aristotle University School of Medicine and a guest researcher in the Immunocompromised Host Section of the National Cancer Institute (NCI) in Bethesda, Maryland, USA. He founded the Research Laboratory of Infectious Diseases in the Third Department of Paediatrics at Aristotle University in 1993. He currently directs the research laboratory as well as the Division of Infectious Diseases of the 3rd Department of Pediatrics. His research interests focus on serious paediatric infections such as fungal infections as well as multi-resistant bacterial serious infections in children and antibiotic stewardship. Professor Roilides is Associate Editor for Clinical Microbiology and Infection, Editor for Journal of Pediatric Infectious Diseases Society and a member of many national and international scientific organizations. He has been on the Board of several national and international medical societies. He has contributed in the organization of several major international congresses including the European Society of Paediatric Infectious Diseases annual meeting in 2012. He is the author of more than 400 peer reviewed articles and book chapters, and he regularly reviews articles for national and international journals. He has contributed as co-ordinator or as partner in several multicentre or multinational studies."

Jana Lass: "My name is Jana Lass and I am a clinical pharmacist working at the Tartu University Hospital, Estonia. One part of my PhD thesis defended at the University of Tartu, institute of Microbiology, focused on the paediatric antibiotic use in the community setting. Also the therapeutic monitoring of antibacterials and training of nursing and medical staff takes a big part of my everyday work."

Dr Charlotte Barker BA BM BCh: "I am a Clinical Research Fellow working at St George’s University of London in the Paediatric Infectious Diseases Research Group, funded by Global Research in Paediatrics (GRiP), an EU FP7 Network of Excellence. My research is focussed on paediatric antimicrobial population pharmacokinetics, and I am coordinating a penicillins pharmacokinetic study (NAPPA) in children and neonates. My other research interests include pharmacovigilance, patient safety, and medical education. After my PhD, I plan to complete my training in Paediatrics and specialise in Paediatric Clinical Pharmacology."

Ana Brett: "I completed my paediatric training in Portugal in 2013, including formal paediatric infectious diseases training at St. George’s Hospital in London, at Texas Children’s Hospital in Houston and at the Great North Children's Hospital in Newcastle-upon-Tyne. I also completed the Postgraduate Diploma in Paediatric Infectious Diseases at the University of Oxford during 2011-2013. I am currently a specialist in the Emergency Service and a member of the Paediatric Infectious Diseases Unit at Coimbra Children's Hospital in Portugal, as well as Young ESPID board representative from 2014-2017. I have been fortunate to be able to participate in the Antimicrobial Resistance and Prescribing in European Children (ARPEC) project and have grown an interest in promoting appropriate antimicrobial prescribing in hospitals through antimicrobial stewardship programmes. I really enjoyed collaborating in this course and hope that it is useful for all students!"

Laura Folgori: "Since the beginning of my paediatric training in Rome, I have always been especially interested in the field of paediatric infectious diseases, particularly in newborns and children affected by primary immunodeficiencies. My research in recent years has mainly focused on the development of the immune system in term and premature babies, and its response to early severe infections. In the last three years, driven by the continuing diagnostic challenges when caring for neonates with sepsis, I have mainly studied the clinical application of diagnostic immunological markers and rapid microbiological tests. Working every day with children who need prolonged antimicrobial treatment, and living in a country with high rates of antimicrobial resistance, I strongly appreciate the need to promote good prescription practices that facilitate correct and appropriate use of available antibiotics, especially in the context of these vulnerable children."

Irja Lutsar MD, PhD: "Irja is a Professor in Clinical Microbiology at the University of Tartu, Estonia. She gained her medical degree at the University of Tartu, Estonia in 1978 and is qualified pediatric infectious diseases specialist. In 1995 to 1998 she was a research fellow at the Southwestern Medical School in Dallas and in 1999 to 2004 she worked as a director in clinical development at Pfizer. One of Irja’s research interest is pharmacokinetic/dynamics of antibacterial agents in various populations. She has been leading investigator in a number of clinical trials in children including studies evaluating pharmacokinetic properties of antibiotics in premature neonates. Irja Lutsar has more than 100 publications in peer reviewed international journals in various fields of the pediatric infectious diseases. She is the member of the Pediatric Committee at the European Medicines Agency and has been active member of ESPID since 1993."

David Pace, MD, PgDip PID (Oxf), FRCPCH: "Hello, everyone. My name is David Pace and I am a Consultant Infectious Disease Paediatrician in Malta where I also coordinate the Postgraduate Training Programme in Paediatrics. I am a member of the ESPID Education Committee and, together with my colleagues, work to promote education and training in Paediatric Infectious Diseases. I am pleased to be part of the antibiotic team at Mater Dei Hospital, the hospital where I work in, and I strive to promote the principles of antibiotic stewardship on the children’s wards. My main research interests include meningococcal vaccines, infections in migrant children and leishmaniasis. I am very enthusiastic about this online Antibiotic Course which I am sure you will find exciting and useful in your clinical practice."

Elias Iosifidis, MD MSc: "Hi everyone, my name is Elias Iosifidis. Currently, I have finished my Pediatric infectious Disease Fellowship and I am working on epidemiology of health care associated infections in pediatric and neonatal intensive care units in a Greek hospital. I finished my MD studies in Aristotle University Medical School, Thessaloniki Greece and then I completed post-graduate studies (MSc) in Medical Research Methodology (Children’s Health Field) of the same Medical School. I have worked (PhD thesis) on relationships between antimicrobial usage and antimicrobial drug resistance as well as implementation of interventions to reduce antimicrobial resistance. My main interests are infection control policies, epidemiology of antimicrobial drug resistance as well as utilization of antimicrobials in children with infections caused by multidrug-resistant bacteria (mainly MRSA, VRE, and multi-drug resistant Gram-negative bacteria)."

Jim Gray: "Jim Gray has been a Consultant Microbiologist at Birmingham Children’s and Women’s Hospitals for 18 years. His clinical interests include surveillance and prevention of neonatal infections, Staphylococcus aureus infections in children and paediatric antibiotic prescribing. Research interests include the epidemiology and treatment of antibiotic-resistant bacteria in neonates and diagnostic test accuracy studies. He has been an Expert Advisor for the British National Formulary for Children (BNF-C) since its inception, and has served on a number of national committees relating to paediatric infectious diseases and antibiotic treatment. He has published widely, and is Deputy Editor of The Journal of Hospital Infection and an Assistant Editor of International Journal of Antimicrobial Agents and the Journal of Pediatric Infectious Diseases."

Stefan Weichert, MD: "I am a pediatrician with a strong interest in paediatric infectious diseases (PID). I started my research and clinical training in Freiburg, Germany, later on had the great opportunity to work in a PID unit in London, UK, and returned to Mannheim, Germany, to complete my training and to further specialize in PID. In parallel to my clinical work my research interest is focused on human breast milk and its beneficial function toward improving child health. It still amazes me how complex nature has provided us with such an antimicrobial and nourishing cocktail, and thereby influences our future health by early orchestrating our gut microbiome. Knowing when and how to use antimicrobials correctly will greatly help us to improve health for our children."

The course targets physicians in general or those undertaking specialist paediatric training leading to a hospital or public health career, and who are likely to be confronted by situations that require knowledge of antibiotic use, or the management of antimicrobial resistance, in neonatal or paediatric patients at the individual or population level. The course is also appropriate for paediatric infectious diseases trainees as an introduction to the topics of antibiotic treatment and antibiotic resistance. It may also be useful for physicians planning to join an antimicrobial stewardship team or carry out antimicrobial stewardship activities for neonatal and paediatric hospital care.

In order to get maximum benefit from the course, you should plan to spend about three hours on it each week.

You will find that some of your time is spent reading and thinking, and the rest of your time will be spent doing a mixture of individual study, using the pre- and post-tests and, where you find it helpful, discussing your thoughts with fellow participants and your online tutor on the discussion forums. In undertaking this course, you are committing yourself to:

  • reading the online course materials
  • contributing to the online community of the course by posting messages to the discussion forums
  • adhering to the online netiquette guidelines outlined later in this section and the terms and conditions you agreed to when you registered for the course.

What you can expect from your tutors
As you work through each module there will be an associated forum where you can post messages for the tutor of that module. If you do so you can expect them to reply to you within the next week, although in most cases it will be sooner.

Overall assessment
After completing all six modules, you will be asked to complete an 18-item quiz made up of questions from each module post-test. You will have three tries to pass this overall assessment, with a passing score of at least 15 correct responses.

Course completion 
In order to receive a course certificate you must complete the six modules; complete the final course quiz and submit the end of course evaluation form.

The practices of courtesy and respect that apply to working with any group also apply online; however, as we cannot see each other when working online, these practices may require even more attention. Although many of you will be aware of how to communicate effectively online at work and elsewhere, here is a summary of the netiquette guidelines as a reminder:

1. Participate
In the online environment, it’s not enough just to turn up. If you don’t join in no one will know that you are there!

2. Share questions and tips
Questions you post to the discussion forums will help others, and taking part in discussions will help you to learn. It is often the case that where a student encounters a problem, it is the experience of the other students that is most valuable.

Although the students on this course will share a common interest in studying the subject, they will come from around the world and bring a range of different personal experiences and also perspectives from different cultures, so, within a group, there will be a great deal of relevant and complementary experience. This means that all members will have something to contribute and a lot to learn from each other.

3. Think before you click
Before you post your comments, check through what you have written. It’s always helpful to check if you have written what you mean and to think how the people reading your words will react.

4. Remember that we can’t see the grin on your face
Help us ‘see’ you by explaining your ideas fully. You could also use an emoji to let the reader know that your comment is meant to be ironic or funny.

5. Remember there is a person who will be reading your message
Because visual clues are often lacking in online communication, electronic messages can easily seem harsher than they are intended to be. If you disagree with what someone has said, please bear this in mind as you express that disagreement.

Abusive messages to other students are not acceptable and any such postings will be removed from the discussion forums. If you have been offended by someone please do not respond on the discussion forum, as this makes things unpleasant for the whole group. You can take the matter to your online tutor, who will help you to resolve it.

6. Keep your messages short and to the point
When composing your messages, aim to express your thoughts concisely. Lengthy postings do not hold people’s attention and are less likely to get a response.

7. Use paragraphs to break up your text
Even relatively short messages can be difficult to read online unless they are broken up.

8. Any derogatory or inappropriate comments are unacceptable
Any offensive postings will be removed from the discussion forums without notice and any serious or persistent breaches of the netiquette guidelines outlined here may result in the discontinuation of the concerned student’s study and access to the course.

Module 1. Key antibiotics
Module 2. History of antibiotic development and PK/PD basics
Module 3. Clinical microbiology: What you need to know to become a better antibiotic prescriber
Module 4. MRSA, PRSP, ESBL E. coli & co.: The key players in antimicrobial resistance
Module 5. Antimicrobial stewardship: Measures to help providers prescribe antibiotics better
Module 6. Antimicrobial resistance

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