Dr Diane Ashiru-Oredope
Lead Pharmacist, HCAI and AMR Division, Public Health England
The primary goal for antimicrobial stewardship is optimising outcomes for patients while minimising unintended consequences.
It is also an approach that aims to reduce the transmission of infections and educate healthcare professionals, patients and the public.
Alongside infection prevention and control, making better use of data and improved diagnostics, antimicrobial stewardship is an essential component of tackling AMR.
Community pharmacy teams have an important contribution and lead role in educating patients and customers on why antibiotics are only prescribed and used when needed, as well as how to effectively manage self-limiting infections.
Patients should be encouraged to return any unused antimicrobials to the pharmacy.
Without antibiotics, there are many conditions that cannot be treated
As professionals, we know that without antibiotics healthcare would take a huge step backwards. Without them we can’t treat chest infections and UTIs, or ensure that our amazing advancements and lifesaving treatments like transplants, chemotherapy and even childbirth remain safe.
Evidence from studies combined together showed that when patients take antibiotics for self-limiting infections where they are unlikely to be effective, we are increasing unintended consequences for those patients.
For example, the common cold and flu symptoms are most likely due to viral infections for which antibiotics have no effect. Both common cold and flu can usually be treated through self-management without the need to see a doctor, with symptoms starting to relieve after around one week.
Community pharmacy teams help with self-management/self-care
Community pharmacy teams are part of the fabric of society, and our teams across the country, who see more than one million people each day, can carry out antimicrobial stewardship interventions that can be contributed in the fight against antimicrobial resistance.
When a customer visits a pharmacy with a prescription, there are usually three stages to the prescription’s journey and therefore three opportunities to implement best antimicrobial stewardship practice.
At hand-in stage, pharmacists can collect information that will later be used to check the antibiotic is appropriate for the patient – and check their infection – as well as help personalise information for the patient.
This includes finding out what infection the antibiotics are for, learning the patient history and what the patient already knows about how to take the antibiotics they have been prescribed.
Advising patients against storing or sharing antibiotics
At the hand-out stage, pharmacists should provide advice about the antibiotics dispensed. This includes taking them at regular intervals as prescribed, whether they need to be taken with or without food, and how long they have been prescribed the antibiotics for.
Patients should be encouraged to return any unused antimicrobials to the pharmacy, and not to dispose of them at home or save them for later or share with others.
Pharmacists should also advise patients if alcohol should be avoided — some patients have misconceptions that alcohol should be avoided with all antibiotics, and sometimes this prevents them from taking their medication.
Antibiotics are not always the solution
Research shows that inappropriate prescribing is, in part, due to patients expecting – or demanding – antibiotics without understanding that they may not be effective for their illness.
There is an opportunity here for pharmacists to help tackle this lack of understanding by giving advice when customers visit feeling unwell.
Key information is available that can be used by pharmacy teams when advising patients with self limiting infections who seek support from pharmacy teams.
This includes usual duration of common infections, which helps to reassure the patient, self care advice to share with the patient, and possible signs of serious illness that should be assessed urgently by a medical team.