Antimicrobial resistance (AMR) is a threat at a global level, currently claiming the lives of an estimated 700,000 people each year. The UN General Assembly approved a wide-ranging declaration in September 2016 aimed at addressing the rising number of drug-resistant infections.
By Shelita Dattani
Several organizations, including the International Pharmaceutical Federation (FIP) and the American Pharmacists Association, have identified antimicrobial stewardship (AMS) as a priority in the outpatient setting with pharmacists playing a key role.
What does it mean to be a steward? It means using the antibiotics we currently have appropriately. It involves targeting the prescribing of an antibiotic – the right drug, dose, route and duration – to the site of infection and the bacteria causing the infection.
Pharmacists are central to antimicrobial stewardship. In hospital settings they have data to influence appropriate prescribing at the patient level and are involved in formal programs to influence utilization at the organization level.
But most antibiotics are prescribed in the outpatient setting, and community pharmacists do have an opportunity to help right now.
Here are some ways:
Education: Pharmacists are well placed to educate patients and prescribers about appropriate use of antibiotics. A simple discussion about whether an antibiotic is needed for a self-limiting illness could make an impact. Discussing the importance of completing a course of antibiotics can make a difference in curbing resistance in a patient. Pharmacists can use best practice evidence and guidelines to help guide prescribers with respect to selection of antibiotics.
Health promotion and prevention: Pharmacists, in their role as immunizers, are already involved in programs such as vaccination against both viral and bacterial disease. They can use these patient interactions to discuss the appropriate use of antibiotics and simple principles around infection control and prevention, such as thorough hand washing.
Appropriate prescribing: In some provinces, pharmacists can prescribe antibiotics for many indications or for certain minor ailments. Some pharmacists also work in collaborative practice environments where they can have a more direct role in influencing choice of antibiotics. In some limited community pharmacy settings point-of-care strep tests have been used to help guide appropriate prescribing of antibiotics.
Working closely with prescribers: Pharmacists can work with prescribers to influence or change prescribing decisions using guidelines and/or microbiology data when available. This is a recognized challenge for most community pharmacists as they often don’t have access to the diagnosis or laboratory results and are often not there to influence the decision at the point of prescribing. As electronic medical records become accessible to community pharmacists, they will have more information at their fingertips to help at the front end.
Further, CPhA is committed to highlighting the vital role pharmacists play in antimicrobial stewardship and is actively participating in a national AMS multi-stakeholder group.
As you can see, there are many simple things pharmacists can do now. And by working closely with prescriber colleagues, learning through professional development, embracing advanced scope and technology changes as they evolve, pharmacists will be even further able to contribute to successfully combating this global crisis.
Shelita Dattani is the Associate Director, Professional Development, Canadian Pharmacists Association