Pharmacists’ Role in Antimicrobial Stewardship
Antimicrobial resistance (AMR) is a major infectious disease concern globally. Many countries have considered it a high priority problem that needs to be addressed. Because of this, several interventions have been carried out to reduce the development of AMR including antimicrobial stewardship programs (AMS). These programs include a set of coordinated interventions that are utilized to improve patient outcomes and reduce antimicrobial resistance. Pharmacists are uniquely positioned to lead AMS programs and play a major role in combating AMR.
What are AMS interventions?
AMS programs have a list of defined interventions that are utilized to achieve its outcomes such as improving patient care, decreasing the rate of AMR development, and reducing cost. These interventions are divided into those that are core and those that are supplementary. There are two main core interventions that are best described by their method of antimicrobial restriction. One method is called restriction and preauthorization. This involves restricting the use of certain antibiotics unless predefined criteria are met. For example, prescribing authority may be limited to infectious disease (ID) specialists for certain antibiotics. This method is very helpful to ensure proper use of certain antibiotics that are high risk for resistance development, expensive, limited in stock, or needed for multidrug-resistant cases. The drawback of this method is that prescribers may be less accepting of it because it limits their prescribing autonomy.
The other core method involves allowing providers to prescribe an antibiotic with a retrospective audit and review by the AMS team within 72 hours of starting it. This allows providers enough autonomy to prescribe antibiotics while still allowing ID specialists to review and provide feedback. This can aid in the development of a more focused plan particularly around the time cultures are reported and more information is known about the organism. One possible drawback of this method is that there could be additional costs and drug waste in areas with limited resources.
Supplementary interventions include optimizing treatment by ensuring patients are receiving the correct dose, route, and duration. Specifically, this may involve switching from intravenous to oral therapy or de-escalating to a narrower spectrum antibiotic. Education and guideline development are also considered supplementary interventions. Any of these interventions can be implemented depending on the healthcare setting’s individual needs and capabilities. The CDC and IDSA guidelines offer further information on AMS implementation and supporting evidence.
Where do pharmacists fit in?
Many successful AMS programs are led by pharmacists. It is clear that pharmacists are perfectly positioned to be involved in any of the interventions previously described.
They are a part of pharmacy and therapeutics committees, can provide oversight on how antibiotics are used and give feedback to the providers about their prescribing patterns. They can also review antibiotic orders and address when antibiotics have been prescribed against guideline recommendations. Pharmacists can also work with microbiologists and review cultures to ensure patients are properly managed. Importantly, pharmacists can verify that their patients are receiving the right dose and frequency based on clinical parameters such as renal functions.
Pharmacists can provide education to other healthcare workers about antibiotic pharmacology and how to utilize pharmacokinetics and pharmacodynamics to improve patient outcomes.
What other roles can pharmacists play in combating AMR?
Pharmacists practice in many settings and can be involved in AMS in community pharmacy, academia, industry, or other areas.
In community pharmacies, pharmacists can ensure that patients are prescribed antibiotics when they have infections that are identified by doctors and ensure are receiving the right dose for the right duration. This is important because if the patient had a lower dose or took their medication for a shorter duration then there will be an increased risk of resistance. In addition, providing education or pamphlets can help educate patients about their antibiotics.
Pharmacy education in academic settings should include AMS modules in order to introduce future pharmacy graduates to the concept and its importance.
In the pharmaceutical industry, pharmacists are involved in the manufacturing of new antibiotics. Additionally, they can run pharmacokinetics studies to improve therapeutic outcomes and optimize dosing and frequency to treat resistant organisms.
These are just a few examples of how pharmacists can act as antimicrobial stewards and help in the fight against AMR.
Overall, pharmacists are crucial members of any AMS team and their role is not just limited to prescription verification. They are involved in many aspects of these programs and are perfectly placed to lead them.
