Pharmacy Check-in: Meet Valerie Leung
Valerie Leung, BScPhm, ACPR, MBA (she/her)
Antimicrobial Stewardship Program Lead, Antimicrobial Resistance and Stewardship
Public Health Ontario
Valerie Leung is the Antimicrobial Stewardship Program Lead within the AMR and Stewardship Team at Public Health Ontario (PHO). Her team is mainly focused on knowledge translation and generating new scientific evidence in the area of antimicrobial stewardship and strengthening AMR surveillance infrastructure and capabilities. Part of Valerie’s role is to align the team’s numerous activities to a broader overarching agenda to reduce the emergence, spread and negative impacts of AMR organisms. Valerie also practises at Michael Garron Hospital in Toronto as a clinical pharmacist where she also supports local quality improvement initiatives.
Q&A with Valerie
In advance of World Antimicrobial Awareness Week, we checked in with a few pharmacists who are passionate about antimicrobial stewardship and how we can all help fight this growing global issue.
What is antimicrobial resistance (AMR) and why is it such a critical issue?
The emergence and spread of drug-resistant pathogens combined with the lack of new antimicrobials being developed has serious consequences, including our inability to prevent and treat common infections leading to more serious and difficult to treat infections. In 2021, The World Health Organization declared Antimicrobial Resistance (AMR) to be one of the top 10 global health threats facing humanity, which has very real consequences both globally and closer to home. In their report “When Antibiotics Fail,” the Canadian Council of Academies estimated that in 2018, more than one-quarter of bacterial infections were resistant to a first-line antibiotic; this same report also estimated that 14,000 Canadian deaths were associated with resistant infections. AMR is a complex problem that we need to address collectively. The Pan-Canadian Action Plan on AMR (https://www.canada.ca/en/public-health/services/publications/drugs-health-products/pan-canadian-action-plan-antimicrobial-resistance.html) outlines 5 pillars of action needed to address this: Stewardship, Research & Innovation, Surveillance, Leadership and Infection Prevention & Control.
Why did you choose to become an antimicrobial resistance and stewardship specialist?
I would characterize my career path as somewhat non-traditional. I started as a hospital pharmacist in emergency and critical care where I found an interest in infectious diseases. Then around the time when antimicrobial stewardship programs in hospitals became an Accreditation Canada Required Organizational Practice, I became involved in implementing a local program from a pharmacy management perspective. Following this, I worked in the health information technology sector helping to advance the use of digital solutions to improve the health of Canadians, including from a public health perspective. This led me to my current position at PHO where my role requires subject matter expertise, but also skills such as collaborative and strategic thinking to advance the antimicrobial stewardship agenda provincially and beyond.
What makes pharmacists ideal partners in combatting AMR?
In any setting, pharmacists are a considered a core member of formal antimicrobial stewardship programs where they exist. Beyond this, the changing landscape of pharmacist prescribing in Canada represents a huge opportunity to make a difference. A key driver of AMR is antimicrobial use, specifically, an overuse of antibiotics often due to unnecessary or inappropriate prescribing. This includes prescribing antibiotics for conditions that don’t require them (such as viral infections) or prescribing durations longer than necessary for uncomplicated infections. The literature tells us that when community pharmacists prescribe antibiotics, they do so appropriately and also help reduce unnecessary antibiotic prescribing.
What role can pharmacists play in educating patients about the dangers of AMR?
In the past, it was thought that stopping antibiotics prematurely would cause bacterial resistance. However, it is now known that it is actually prolonged exposure to antibiotics that results in the selective pressure that drives AMR. In other words, resistant strains of an individual’s normal flora or acquired bacteria can develop following prolonged antibiotic therapy. Practically, pharmacists can advise patients to avoid saving leftover antibiotics for later use, avoid sharing antibiotics and return antibiotics to the pharmacy for proper disposal.
Do you have any practical tips on how pharmacy teams can implement antimicrobial stewardship programs or processes in their pharmacies to help combat AMR?
For pharmacists working in primary care settings, I think The Cold Standard toolkit by Choosing Wisely Canada is a great place to start. Community pharmacists are busy and the toolkit contains patient education posters that can be implemented passively. There are also good recommendations on antibiotic durations for upper respiratory tract infections that may be helpful when assessing prescriptions for appropriateness.
What makes you proud to be a pharmacist?
Pharmacists are problem solvers, critical thinkers and ultimately, doers! I am proud of the resilience demonstrated by pharmacists during the pandemic. I believe that this has increased our profile in the field of public health, and will lead to more opportunities to work synergistically with others to improve population health.