Community pharmacists as antimicrobial stewards? You bet!
By Shelita Dattani, Associate Director, Professional Development, Canadian Pharmacists Association
Antimicrobial resistance (AMR) is a threat at a global level, currently claiming the lives of an estimated 700,000 people each year. No less than the UN General Assembly approved a wide-ranging declaration in September 2016 aimed at addressing the rising number of drug-resistant infections.
Several organizations, including FIP and the American Pharmacists Association, have identified antimicrobial stewardship as a priority in the outpatient setting and have said that pharmacists have a frontline role to play in the fight against AMR.
But what does it mean to be a steward? Simply, 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 already play a key role in antimicrobial stewardship in hospitals and other collaborative practice environments. In those settings, they have data to influence appropriate prescribing at the patient level and are involved in formal programs to influence utilization patterns at the organization level.
Most antibiotics are prescribed in the outpatient setting and community pharmacists also have an opportunity to engage in antimicrobial stewardship activities 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 on whether it is started in a given patient. Discussing the importance of completing a course of antibiotics can make a difference in curbing resistance in a patient. More broadly, 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 this one-on-one time with patients 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 primary care 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 best practice evidence and/or culture and sensitivity data when available. This is a recognized challenge for most community pharmacists as they often don’t have access to the diagnosis or microbiology 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 and will be able to be of greater help at the front end.
Further, CPhA is committed to highlighting the vital role pharmacists play in antimicrobial stewardship and is participating in an AMS Canada Steering Committee, a national multi-stakeholder, multi-sector group led by the National Collaborating Centre for Infectious Diseases and HealthCareCAN. CPhA is also providing significant input through roundtable discussions to a working federal Action Plan and by participating on a PHAC led AMR task group.
There are many simple things that pharmacists can do now. And by working closely with prescriber colleagues, learning through professional development, embracing advanced scope and technology changes as they evolve, they will be even further able to contribute to successfully combating this global crisis.
Antibiotic Awareness Week takes place from November 14–20, 2016 and is endorsed by the World Health Organization, acknowledging the global importance of this growing public health issue.