Antimicrobial Stewardship (AMS) simply means organized programmes or interventions that focuses on the proper and rational use of Antimicrobial to improve therapeutic outcomes and reduce Drug resistance. Therefore,it is the core duty of an AMS Pharmacist or any other antimicrobial steward in the health sector to make sure that the misuse or overuse of antimicrobial is discouraged.
However, According to Clinical Microbiology and Infection (CMI), “Antimicrobial stewardship originated within human healthcare, it is increasingly applied in broader contexts including animal health and one Health”.1 Therefore, it means different things to different countries, different literature and different health care bodies.
Nevertheless, irrespective of the differences in AMS definition, the core interest of every steward is to minimize the incidence and occurrence of Antimicrobial resistance (AMR) with regards to proper use of antibiotics.
The emergence of organisms that can resist different classes of Antimicrobials has become a great nightmare. The leading cause to this nightmare is the use of antibiotic without Prescription. A survey with 35 communities from five continents showed that non-prescription use of Antimicrobials occurred worldwide and accounted for 19–100% of antimicrobial use outside of northern Europe and North America.2
AMR is the leading cause of death globally. In European countries alone, AMR is responsible for 33,000 deaths per year and costs EUR 1.5 billion per year in healthcare costs and productivity losses.3
In addition, irrational use of antibiotics are Drug therapy problems, Longer stay in the hospital, increase cost of treatment and death.
The AMS Pharmacist
According to the Centers for disease and control prevention, one of the core elements of Hospital Antibiotic Stewardship Programs is to appoint a drug expertise or a Pharmacist who will be responsible for working to improve antibiotic use.4 In summary, these responsibilities can extend to other aspects of pharmacy such as the primaery health care setting and community pharmacy.
Generally, the core duties of an AMS pharmacist includes;
- Procurement of cost-effective drugs that will be part of the hospital drug essential list.
- To be part of the decision making process as regards to choosing the right antibiotic for a patient.
- Drug monitoring and documentation to make sure the use of antibiotics are optimized.
- Pharmacovigillance and report of Adverse drug reactions that may arise from Antibiotic use.
- Organizing seminars and other educative platforms to create awareness to other health professionals and patients on the ways to improve antibiotic use.
However, in community setting and primary health care homes, the responsibilities are same but an additional effort is required in making clinical decisions when filling a prescription or treating a common illness.
Nevertheless, the AMS pharmacist may not be effective in carrying out these responsibilities if he is not equipped with proper knowledge and current information on the rational use of antibiotics. Therefore, additional education is a prerequisite to become a good AMS pharmacist.
Role of an AMS Pharmacist in improving antimicrobial stewardship
Antimicrobial stewardship is a responsibility of all health care team. But, there are specific roles a pharmacist should play to make sure that AMS is effective both in primary and secondary health care facilities. Below are some of these roles of a Pharmacist in Antimicrobial stewardship;
Ensuring good supply chain management and antibiotic regulation
One of the leading cause of antimicrobial resistance is the weak implementation in the regulation of antibiotics. In developing countries where antibiotics are sold as over the counter drugs, there is a great tendency for antibiotics to be misused.5
Nevertheless, even the developed countries with a working drug regulatory bodies have a take to drug misuse through self medication. A study in Europe has that 73 to 449 per 1000 adults practices self medication when it comes to antibiotics use for minor ailments such as sore throat.6
In summary, it is a basic obligation of a pharmacist to make sure that these antibiotics are not easily available to every Dick and Harry.
Discourage unnecessary drug therapy:
Centers for Disease Control and Prevention said that 20-50% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or inappropriate. Also, in primary care, use of antibiotic to treat diseases such as sore throat, common cold, acute otitis media, acute infective conjunctivitis, acute bronchitis and acute sinusitis have a limited value.7 Hence, antibiotic use can be a last resort to these ailments.
Encourage the patients to follow their Antibiotic course
It is a common thing for one to stop an antibiotic earlier than prescribed when one feels relieved from the symptoms. In any case, this is a wrong way to use antibiotics since organisms that manage to survive when the antibiotic is withdrawn tend to easily form resistance to that particular antibiotic.
Consequently, the pharmacist have to make sure the frequency, dose and duration of antibiotics are clear to patients. Also, drug monitoring can help the pharmacist keep track of adherence or compliance.
Educate patients on the dangers of wrong use of antibiotics
Ignorance and lack of education have a contributing effect to the way patients see and use antibiotics. Problem arises when the Pharmacists at the point of dispensing assumes the patients knows the right thing to do with their antibiotics. Even if they do, always try to remind them of the dangers of not using antibiotics the way they should.
Therefore, during patient counselling, the pharmacist should stress the dangers of Antibiotic Misuse and self medication.
Assist in making clinical judgements
Pharmacists should be part of ward rounds and patient review. Antimicrobial stewardship is a joint effort from all the professionals. A contribution from a pharmacist during clinical judgement and implementation will help to improve the rational use to antibiotics.
Good dispensing practice
It is the duty of the pharmacist to make sure that the prescriptions they fill are valid. This can be done by checking the date the prescription was written and from what Authority it is coming from.
Also, in the community settings where pharmacists can prescribe antibiotics for the treatment purposes. It is important that each prescription is given based on a standing evidence of antimicrobial sensitivity from a laboratory result..
Improve in Pharmaceutical researches
The fields of pharmacognosy and pharmaceutical chemistry have so many potentials in bringing forth new antibiotics that will replace or substitute the old ones.
It is common that organisms have developed resistance to most of the conventional antibiotics. Therefore, there is need to make available drugs from other sources which will be effective in addressing these resistant organisms. Proper research from pharmacists can help ease the burden of antimicrobial resistance.
To incorporate AMS as apart of training for Pharmacist education
Finally, it is difficult to do well as an AMS pharmacist without a proper knowledge on the resistance pattern of microorganisms to antibiotics. Hence, training pharmacists in the field of antimicrobial stewardship can help them when making the right decision on how to procure, store and dispense antibiotics.
To prompt physicians on antibiotic time outs
Usually, on admission to the hospital, an empirical use of antibiotic is inevitable while waiting for the laboratory data to be out. This period of time can last within 48 – 72 hours. Time out is a period when the physicians will review the patient and decide if the patient should be on antibiotics or not. Also, to access if the patient is on the right antibiotic or not.
It is the duty of the pharmacist to prompt the physicians when time out is due for a patient.8
Antimicrobial stewardship is a joint effort of the medical team. But, the AMS pharmacist is obliged to be more careful since he is the last defense line to make sure the right antibiotics are used by patients. Therefore, any laxity on his part will cause a therapy failure, adverse drug reaction or even death.
Therefore, Pharmacists should be grounded in the field of Antimicrobial Stewardship and Resistance to be a renowned AMS pharmacist.
- Dyar, O.J. et al. (2017, November).What is antimicrobial stewardship?.Clinical Microbiology and Infection , Volume 23 , Issue 11 , 793 – 798. Source; [CMI]
- Morgan, D. J., Okeke, I. N., Laxminarayan, R., Perencevich, E. N., & Weisenberg, S. (2011). Non-prescription antimicrobial use worldwide: a systematic review. The Lancet. Infectious diseases, 11(9), 692-701. source [NCBI]
- European commission, (2017, June). EU action on antimicrobial resistance. web. 26th June 2019. Source [ec.europa.eu]
- Center for disease control and prevention. (2015, May 7). Core Elements of Hospital Antibiotic Stewardship Programs. web. 26th June 2019. source [CDC]
- J A. Ayukekbong et al. (2017, May). The threat of antimicrobial resistance in developing countries: causes and control strategies.web.26 June 2019 source. Antimicrobial Resistance & Infection Control.
- Grigoryan L, Haaijer-Ruskamp FM, Burgerhof JG, et al. Self-medication with antimicrobial drugs in Europe. Emerg Infect Dis. 2006;12(3):452–459. doi:10.3201/eid1203.050992
- Pharmaceutical journal (2011, October). Pharmacists have a critical role in the conservation of effective antibiotics. web. 26th June, 2019. Source. [Pharmaceutical journal]
- L Vasina, M Dehner, A Wong, S Bojak, S Dhoot, D Shaw, K Jain, S Gardner, R Chinn (2017, October) The Impact of a Pharmacist Driven 48-hour Antibiotic Time Out during Multi-disciplinary Rounds on Antibiotic Utilization in a Community Non-teaching Hospital, Open Forum Infectious Diseases, Volume 4, Issue suppl_1, Fall 2017, Pages S272–S273, https://doi.org/10.1093/ofid/ofx163.605