Rachel Mortlock
Pharmacist
AMR is declared to be one of the top 10 global public health threats facing humanity. The WAAW 2022 campaign materials state that in 2019, nearly 5 million human deaths worldwide were associated with bacterial AMR — of which 1.3 million human deaths were directly attributable.1
World Antimicrobial Awareness Week (WAAW), a global campaign founded by the World Health Organisation (WHO) to improve awareness and understanding of antimicrobial resistance (AMR) through effective communication, education and training has just come to a close. This year’s theme was ‘Preventing Antimicrobial Resistance Together’ with all sectors called on to encourage the prudent use of antimicrobials and increase the prevention of AMR through a collaborative approach.
Rising antibiotic resistance
There is a paucity of innovative antimicrobials in development, but high rates of resistance against antibiotics used to treat common infections — including urinary tract infections, sepsis, sexually transmitted infections and some forms of diarrhoea — are being seen globally. Antiviral and antifungal resistance are also growing concerns, particularly in immunocompromised patients.
When faced with a dispensary bench replete with prescriptions waiting to be filled, it can be difficult to recognise how community pharmacists can play their part. AMR is driven by the overuse and misuse of antibiotics, and preventing infection is key to breaking the cycle of infection transmission. We are already working in a pressurised environment, and tackling these huge, potentially existential issues can sometimes be too overwhelming to contemplate.
Pharmacy staff who are usually the first point of contact for the public can also help.
How pharmacists can help
Community pharmacists have more contact with the general public than any other healthcare professional, so they can educate the public and foster good antimicrobial practices. Supporting patient self-care and reducing expectations and demand for antibiotics are two areas where pharmacists have a significant role to play.
Pharmacists are best placed to advise on the OTC remedies available for symptom control for coughs and colds and to remind the public that antibiotics are not effective against the viruses that often cause these ailments.
Pharmacy staff who are usually the first point of contact for the public can also help. Being aware that coughs can, for example, last more than a week, they can discuss the self-limiting nature of conditions with patients. Not referring patients prematurely to the GP can reduce unnecessary consultations and inappropriate antibiotic prescribing. Such advice can be delivered swiftly during the routine course of an OTC discussion. Promoting vaccinations, such as the seasonal flu jab, can similarly be carried out by pharmacy staff and will support infection prevention.
Taking antibiotics correctly
Being alert to local prescribing policies and routinely counselling patients on antibiotic use behaviour at the point of dispensing contribute to the WHO’s notion of collaboration. Pharmacists or appropriately trained pharmacy staff should counsel patients to take their antibiotics exactly as prescribed and that doing so means bacteria are less likely to become resistant.
Common side effects can be warned about. Advising which antibiotics can or cannot be consumed with alcohol is worthy of consideration as stopping antibiotics due to a social occasion (especially with the impending festive season) is certainly not unheard of. Leftover antibiotics should be returned to the pharmacy, and a gentle reminder that sharing or saving antibiotics is an absolute ‘no-no’ will not go amiss.
Community collaboration
In summary, despite the colossal and seemingly unassailable challenge posed by AMR, everyone has a role. While not being anchored to R&D laboratories or driving policy decisions, community pharmacists and their colleagues can still play their part. By working with other local HCPs and continuing to educate and advise the public and patients, pharmacists can contribute to the WHO’s collaborative approach.
Antimicrobial guidelines for community prescribers are available on antibioticprescribing.ie and can be referred to when reviewing prescriptions during the dispensing process, with the GP contacted if necessary.
[1] Antimicrobial Resistance Collaborators. (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet; 399(10325):P629-655. DOI: https://doi.org/10.1016/S0140-6736(21)02724-0