Pharmacists should lead the fight against antibiotic resistance.
We live in an era where the drugs in our antimicrobial arsenal sometimes have close to no clinical efficacy against the bacteria they’re intended to destroy.
By now, most health care professionals recognize antibiotic resistance, especially now that it’s national Get Smart About Antibiotics Week (November 16-22, 2015). But the question of how to best manage this phenomenon remains.
Pharmacists can play a critical role in coordinating better strategies to enhance antimicrobial stewardship. Often, they are already working directly with medical and nursing staff to ensure that patients are prescribed the best treatment by advising on drug selection, dose, and administration method.
Nevertheless, the International Pharmaceutical Federation (FIP) recently published a report that called for greater pharmacist involvement in antimicrobial stewardship efforts and detailed specific contributions that pharmacists can make.
“Pharmacists can’t just expect others to do it,” said Fred M. Eckel, ScD, Editor-in-Chief of Pharmacy Times. “We must make our own contributions if we want to fix this problem.”
Here are some ways pharmacists practicing in all care settings can continue to fight antibiotic resistance:
1. Counsel Patients in Community Pharmacy Settings
Community pharmacists are usually a patient’s most direct point of contact with respect to their medications. This accessibility affords pharmacists the opportunity to play a pivotal role in community education efforts.
Last year, independent pharmacies garnered the best ratings for speed, accuracy, helpfulness, and pharmacist’s knowledge, according to a survey by Consumer Reports. Patients reported appreciation for independent pharmacies’ shorter wait times and greater availability of medications in stock.
Results like these indicate that enhanced stewardship strategies could reach a wider patient network if they were implemented independently in community pharmacies.
The aforementioned FIP report cites specific examples of education initiatives that pharmacists can undertake in their communities, especially with respect to hygiene. Such initiatives include “hand-washing and hygiene practices, correct sneezing/coughing protocols, and isolation of infected patients.”
2. Make Sure Everyone Knows How Important Immunizations Are
All 50 US states plus the District of Colombia have statutes permitting pharmacists to administer vaccines at some level, and many of those statutes are evolving to keep pace with changing patient attitudes towards pharmacists and immunizations.
Ohio, for example, adopted a new law in March 2015 allowing pharmacists and pharmacy interns to provide flu shots to all patients ages 7 and older. Previously, pharmacists and pharmacy interns were only permitted to administer the vaccines to adults ages 18 and older.
Education about the seriousness of influenza transmission is also a potential role for pharmacists. According to a recent survey from CVS,67% of working Americans report that they would go to work despite having flu-like symptoms.
In light of this, the US Centers for Disease Control and Prevention (CDC) has urged pharmacists to recognize and optimize their role in promoting influenza vaccines ahead of flu seasons.
Pharmacists can also help improve vaccination rates by making concerted efforts to quell misguided fears of vaccines, including the link between autism and thimerosal—the mercury preservative that was found in some vaccines.
Pharmacists should also familiarize themselves with recent immunization updates.
3. Prevent Unnecessary Antibiotic Use for Non-Bacterial Infections
As many as 1 in 10 health care providers prescribe antibiotics for almost every patient they see presenting with cold or bronchitis, so it should come as no surprise that many patients just assume that antibiotics will cure any ailment.
As pharmacists already know, antibiotics are not effective against viruses and therefore should never be used to treat them. It’s important for pharmacists to debunk this misconception and guide patients on proper antibiotic usage.
This is especially prevalent in the context of geriatric care, as “over the course of a year, 50% to 70% of [nursing home] residents will receive 1 or more courses of antibiotics, and 25% to 75% of antimicrobial use in nursing homes may be inappropriate,” according to CDC medical epidemiologist Nimalie Stone, MD, MS.
4. You Can’t Spell “Hospital Health Care Team” Without “Team”
Because of changing payment models, many facilities are now recognizing the value of the pharmacist in optimizing patient outcomes, though many others are still lagging on forming pharmacist collaborations.
Pharmacist engagement on health care teams in hospitals can help ensure that antimicrobial stewardship efforts are embedded into hospital infection control practices at every level.
For example, many hospital sterilization services are not managed by a dedicated department, but by the hospital’s surgical or nursing staff.
However, with their training in microbiology and aseptic technique, pharmacists are aware of the functions that sterilization services are expected to perform.
Why else should pharmacists be closely integrated into hospital antibiotic stewardship efforts?
“It’s very clear why: The pharmacist is looking at the entire picture, not just the antibiotics, so they’re picking up things like drug interactions…and have access to drug information as fast as anyone,” J. Russell May, PharmD, FASHP, told Pharmacy Times.
As the authors of the FIP report asserted, “All hospitals should have an antimicrobial lead pharmacist who promotes antimicrobial stewardship. This is a perfect scenario where pharmacists can manage the correct use of antimicrobials, and have a remarkable and positive impact on [antimicrobial resistance] prevention.”