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Antimicrobial stewardship in Scotland: impact of a national programme

Dilip Nathwani1*, Jacqueline Sneddon2, Andrea Patton3 and William Malcolm4

Author Affiliations

1 Ninewells Hospital & Medical School, Dundee, DD19SY, UK

2 Scottish Medicines Consortium, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK

3 Healthcare Improvement Scotland, Elliott House, 8-10 Hillside Crescent, Edinburgh EH7 5EA, UK

4 NHS National Services Scotland, Health Protection Scotland, Meridian Court, 5 Cadogan Street, Glasgow G2 6QE, UK

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Antimicrobial Resistance and Infection Control 2012, 1:7  doi:10.1186/2047-2994-1-7

Published: 3 February 2012



The Scottish Antimicrobial Prescribing Group (SAPG) was established by the Scottish Government in 2008 to lead the first national initiative to actively address antimicrobial stewardship. Healthcare associated infection (HAI) is a priority in Scotland and the work of SAPG contributes to the national HAI Delivery Plan. SAPG's early work has focused on restricting the use of antibiotics associated with a high risk of Clostridium difficile infection (CDI) and development of national prescribing indicators to support reduction of CDI.


Scottish Antimicrobial Prescribing Group has developed prescribing indicators for hospital and primary care, which are measured and reported in all 14 NHS board areas. Improvement in compliance with the indicators has been demonstrated with resultant reductions in CDI rates and no adverse effect on mortality or antimicrobial resistance patterns.


The establishment of a Scottish national antimicrobial stewardship programme has made a significant contribution to the HAI agenda, particularly in relation to CDI. The programme is supported by local antimicrobial teams, a national framework for education, surveillance of antimicrobial use and resistance and sharing of data for improvement. Antimicrobial stewardship has been integrated with other national programmes on patient safety and quality improvement.

Antimicrobial stewardship; Clostridium difficile infection; prescribing indicators; quality improvement