Pharmacist Role Antimicrobial resistance Prevention

Role of Pharmacists in Preventing Antimicrobial Resistance

Compiled by Alok Bains

Antibiotics, more accurately antimicrobial agents, are used to control or kill microorganisms. Antimicrobial resistance (AMR) develop if bacteria, virus, fungi, parasites, etc do not respond to antimicrobial agents. AMR is a natural process but overuse and misuse of antimicrobial agents contribute to speeding up AMR in microorganisms. World Health Organization's (WHO) Global Action Plan to control antimicrobial resistance threat was initiated in May 2015 with the following five objectives:

1. Awareness of Antimicrobial Resistance.

2. Surveillance and research.

3. Reduction in the incidence of infection.

4. Optimization of Antimicrobial agents use.

5. The invention of new medicines, diagnostic tools, vaccines etc.

WHO declares AMR as one of the top 10 global public health threats.

Pharmacists' Role to Prevent AMR

WHO survey states pharmacist has a decisive role to control AMR. Both Community Pharmacists and Hospital Pharmacists play their roles control AMR.

A. Community pharmacist:

Community pharmacists are the entry gate and first point of contact for the public. They educate the community about their medical needs. This includes health promotion, infection minimization, triage, optimal treatment and quality medicines. These activities reduce the infection and lead to minimising misuse of antibiotics. Community pharmacists prevent and control infections and reduce the use of antimicrobial agents by the following activities

1. Health promotion: Community pharmacists increase the immunity of the community by followings

   • Promoting healthy lifestyle in the community

   • Organize National Pharmacy Weeks mainly aim for a public healthy lifestyle.

   • Prevention of infections by hand hygiene, sneezing/coughing etiquettes, infected patients isolation, etc awareness.

   • Participating in National immunization programs.

2. Triage: The analysis of the process to treat patients in the community pharmacy and their referral to another health care professional is called triage. Community pharmacists play a role to reduce antimicrobial use through the following actions:

   • Appropriate treatment of symptoms without the use of antimicrobial agents.

   • Some countries authorize Community pharmacists to prescribe and dispense antibiotics; Such as the UK, New Zealand and some provinces of Canada, etc.

   • Minor health ailment treatment by using over-the-counter medicines (OTC).

   • Patients' referrals for serious health problems to the appropriate specialist. In India, Community pharmacists convince TB patients to DOT facilities. DOTS control antimicrobial resistance in TB patients.

3. Optimal treatment management: It is a must to reduce AMR. It requires dosage adherence and minimizing the interactions.

   • Adherence: Pharmacists are experts to manage long-term, short-term and any specific antimicrobials use.

     • Long-term treatment: Most challenging task in long-term treatment is compliance by the patient with dosage. Noncompliance develops the risk of AMR. Community pharmacist remains in direct contact with the patients to convince them of their compliance.

     • Short-term treatment: Community pharmacists follow up with patients on an antimicrobial prescription for the short-term. This helps patients to complete their prescribed dose.

     • Specific cases: The dose of antibiotics depends upon patients such as pediatric, adult, geriatric, etc. Pharmacists are the best expert to tackle this to avoid any unwanted effects on patients and patients' refusal to stick with the dosage regimen. Sometimes the flavour of the dosage form is disliked by the patient, especially pediatric patients. This also develops noncompliance with the dosage regimen. It can be easily tackled by pharmacists.

   • Minimizing interactions: Lack of knowledge may lead to medicines-medicine interactions or food-medicine interactions. This will lead to noncompliance with the dosage regimen. Pharmacists are the best professionals to look into this to avoid these interactions.

4. Quality of the medicines: If medicines have less amount of antimicrobial medicine in dosage, it will lead to AMR. Pharmacists being the legal lord of medicines can check these substandard drugs in the best interest of patients.

B. Hospital pharmacists:

Many hospitals implemented antimicrobial stewardship programs to optimize antimicrobial use. In most hospitals, pharmacists lead antimicrobial stewardship programs. Pharmacists develop and manage antimicrobial practice guidelines. They help prescribers to optimize antimicrobial prescriptions, monitor antimicrobial uses, and educate healthcare service providers, patients and the public. For these purposes, they do the followings

1. Prescription Surveillance: Review individual patient prescriptions with antimicrobials.

2. Hospital formulary: Enforcement of hospital formulary to develop a support system for prescribers, practice guidelines and restrict antimicrobial uses.

3. Guidance on dosage and administration of antimicrobial agents.

4. Review the antimicrobial duration of therapy,

5. Pharmacokinetic monitoring of antimicrobial drugs.

6. Monitoring outcome of antimicrobial therapy.

7. Assessing antimicrobial prescriptions on the discharge of the patient.

8. Patient and public education about the proper use of antimicrobial agents.

Compiled by Alok Bains