This week is World Antibiotic Awareness Week, which is an opportune time to showcase the great work that pharmacists from across the commonwealth are doing to champion and lead on tackling AMR.
A fundamental pillar of tackling AMR are initiatives fostering antimicrobial stewardship (AMS). Stewardship of antimicrobials is required to ensure antimicrobials are used appropriately, optimising patient outcomes whilst minimising risks for antimicrobial resistance, in keeping with local guidelines, and reflecting resistance data.
It is widely acknowledged the benefits AMS activities can have; an international review of 660 hospital AMS programmes demonstrated they are able to drastically improve healthcare outcomes. Where assessed, 96% reported a decline inappropriate prescribing, 58% reported reduction in resistance, and the majority saw reduced expenditure and improved patient outcomes.
This study highlighted that AMS programmes are typically led by antimicrobial or infectious diseases pharmacists in Asia, Europe, North America and Oceania, but not yet in Africa.
A few months ago, you will have seen that CPA and collaborators, The Tropical Health Education Trust, have been awarded a prestigious grant from the Fleming Fund to build partnerships between UK hospitals and those in 4 low and middle income Commonwealth countries. The scheme aims to support their antimicrobial stewardship activities and address priorities in the following areas within local settings
a. Development, implementation and evaluation of antimicrobial stewardship (AMS), especially surveillance of antimicrobial consumption
b. Infection prevention and control (IPC);
c. Antimicrobial pharmacy expertise and capacity
The partnerships will be established by multidisciplinary teams of UK NHS staff including pharmacists. Exemplifying mutual professional respect and joint working to support antimicrobial stewardship will be a core aspect of this. Therefore, the scheme will highlight the expertise pharmacists are able to impart, as well as building capacity through training and development of clinical support tools. Moreover, through AMS, we aim to support capacity for wider clinical pharmacy skill development; a role still in its infancy in many low resourced healthcare settings, with a lot to offer resource-limited healthcare infrastructure.
Outside of hospitals, antimicrobials are available in many settings without prescription. Patients often seek antimicrobials without being full informed of the ‘when’ and ‘how’ they should be administered, or without first seeking medical advice. A recent survey conducted by the CPA to understand antimicrobial seeking behaviours highlighted patient knowledge may be a key influencing factor on whether they seek a prescription first. Community pharmacists are optimally placed to provide support to educate patients and challenge inappropriate antimicrobial use behaviours to ensure antimicrobials are used correctly. The Commonwealth Pharmacists’ Association are working with design and behaviour experts from Universities in the UK and Rwanda to develop an effective, evidence-based Community Pharmacy AMR Campaign.
This WAAW we are working with pharmacy associations throughout the Commonwealth to highlight examples of pharmacists leading at a strategic level to tackle AMR. Pharmacists hold invaluable AMR expertise that can benefit how policies are designed and implemented. The examples below demonstrate pharmacists are able to play an important part to ensure policies consider appropriate antimicrobial use and provide leadership on directing research.
We believe pharmacists, alongside other healthcare professionals involved in antimicrobial use, should contribute to AMR strategy and call to national and global policy makers that such an approach be adopted across all settings. Pharmacists should be a fundamental aspect of AMR policy development.
Europe – United Kingdom
Philip Howard is currently a Consultant Antimicrobial Pharmacist at the Leeds Teaching Hospitals, holds an Honorary Senior Lecturer position at University of Leeds and works on secondment to NHS-Improvement as an AMR Project Lead. He has been actively involved in antimicrobial stewardship and represented the profession at a national, European and global level for the last ten years.
His appointed as the president of the British Society for Antimicrobial Chemotherapy in 2018 was a landmark moment for the Society and the first time in its 45 year history that a pharmacist has been appointed President. The past president Professor Dilip Nathwani an ID physician at the time of the appointment stated that: the election of Philip Howard rightfully recognises the central and critical role pharmacists play in both infection management and antimicrobial stewardship.
Thought from Philip Howard
‘Antimicrobial resistance is one of the greatest threats facing the planet, estimated to contribute to 700,000 deaths globally every year. The challenge is to coordinate action nationally as well as globally, and pharmacists across all sectors can play a vital role in terms of patient care as well as leading on action planning.’
Africa – Ghana
Martha Gyansa-Lutterodt, the Director of Pharmaceutical Services and also the Chief Pharmacist of Ghana, is the current chair for Ghana’s Antimicrobial Resistance Working group that responded to the Global Action Plan on antimicrobial resistance with a country working mechanism. With her Team she led the development of a National Policy and also National Action Plan on AMR for Ghana.
Thought from Martha Gyansa-Lutterodt
‘Resource mobilisation to support implementation of National Action Plans in all thematic areas are strategic to the step by step management of antimicrobial resistance. All professionals in human, animal and environment must be on board. Together we can do it so no one is left behind!’
Africa – Uganda
Winnie Nambatya is a lecturer in clinical pharmacy, Department of Pharmacy, College of Health Sciences, Makerere University and led the first voluntary research scheme developing clinical pharmacy in Uganda.
Thought from Winnie Nambatya
‘If we use antibiotics inappropriately or when they are not needed, they may not be available when we need them because of resistance.
In Uganda, pharmacists’ input in programmes plays a vital role in AMS, including through the following:
• The multisector medicines and therapeutic committees where they act as secretaries and help choose appropriate medications, especially antibiotics
• Infection prevention control programmes
• Education programmes where they train healthcare professionals on the different antibiotics. This is particularly important in Uganda as despite a large number of antibiotics, many hospitals lack formularies hence The Pharmaceutical Society of Uganda, sets out training programmes and invites all health professionals to partake
• Initiatives by organizations such as the Global Security Agenda, which support assessment of the rational use of antibiotic consumption’
Asia – Sri Lanka
Mrs. Sakeena Hameem is a PhD Scholar, Sydney Pharmacy School, The University of Sydney, Australia as well as Senior Lecturer, Department of Pharmacy, University of Peradeniya, Sri Lanka. Her research expertise includes assessing antimicrobial use behaviours through clinical pharmacy.
Thought from Sakeena Hameem
‘Pharmacists in community pharmacies are most accessible healthcare provider for patients as these pharmacies open for long hours, and usually does not require an appointment. Pharmacists are the first contact person of patients seeking advice on common health complaints and can provide valuable advice on self-management of minor ailments, including cold and flu conditions. Pharmacists are in a good position to advice on patient demands for antibiotics with the option of referral to a physician if necessary. Furthermore, they are the last contact person before the patient start antibiotic treatment. Hence, pharmacists can play a pivotal role to strengthen the appropriate use of antibiotics in the community. To achieve this, comprehensive and relevant education and training on the use of antibiotics and AMR is essential for pharmacists.’
Asia – India
Manjiri Gharat is the Vice-President of The Indian Pharmaceutical Association and Chairperson of the Community Pharmacy Division. Training on AMR and responsible antibiotic use is a priority of the association, who will be broadcasting a webcast on the topic over World Antibiotics Awareness Week, as well as conducting campaigns, media interviews and articles through individual IPA branches. Moreover, it will be a theme for their national pharmacy week starting November 3rd.
Thought from Manjiri Gharat
‘As India has poor health literacy, incorrect use of prescribed medicines and self medication are very common. Pharmacists therefore have a major role to:
1. Not dispense antibiotics without valid prescription
2. Counsel patients on their antibiotic prescription to ensure appropriate use and adherence
3. Create awareness in the community about how to prevention infections.’
Americas – Trinidad & Tobago
Tobago – Allyson Pouchet
Allyson Pouchet is the Vice President of The Pharmaceutical Society of Trinidad & Tobago.
Thought from Allyson Pouchet
‘The pharmacists’ role in combating antimicrobial resistance is important in the healthcare team in Trinidad and Tobago as we conduct retrospective research to ensure that there are standard clinical classification for diagnosis to inform on the appropriate use, dose and duration of antimicrobials by providing sound evidence endemic to our areas of practice and that will strengthen our policy on antimicrobial use. As antimicrobial guardians, pharmacists also improve the literacy of our patients through lectures by promoting alternative approaches to coping with self-limiting diseases such as the common cold and flu.’
Trinidad – Patricia Sealy
Patricia Sealy is Chair of the Education Committee, of The Pharmaceutical Society of Trinidad & Tobago as well as a Clinical Health Lecturer at School of Pharmacy, Faculty of Medical Sciences, The University of The West Indies.
Thought from Patricia Sealy
‘Pharmacists in Trinidad have been engaged in conducting Point Prevalence Surveys at select institutions and health centres in Trinidad, as well as raising awareness of antimicrobial resistance generally. The data collected has been key to:
- make inferences about antimicrobial prescribing in hospitalized patients
- determine if antimicrobial stewardship of antimicrobials are promoted to minimize antimicrobial resistance
- and ultimately to make appropriate recommendations for treatment if stewardship is not being executed.’
 Howard, P., C. Pulcini, G. Levy Hara, R. M. West, I. M. Gould, S. Harbarth, and D. Nathwani. “An International Cross-Sectional Survey of Antimicrobial Stewardship Programmes in Hospitals.” Journal of Antimicrobial Chemotherapy 70, no. 4 (April 1, 2015): 1245–55. https://doi.org/10.1093/jac/dku497