A systematic literature review and meta‐analysis of community pharmacist‐led interventions to optimise the use of antibiotics

Abstract

The aim of this systematic review is to assess the effects of community pharmacist-led interventions to optimise the use of antibiotics and identify which interventions are most effective. Methods: This review was conducted according to the PRISMA guidelines (PROSPERO: CRD42020188552). PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched for (randomised) controlled trials. Included interventions were required to target antibiotic use, be set in the community pharmacy context, and be pharmacist-led. Primary outcomes were quality of antibiotic supply and adverse effects while secondary outcomes included patient-reported outcomes. Risk of bias was assessed using the 'Cochrane suggested risk of bias criteria' and narrative synthesis of primary outcomes conducted.Results: Seventeen studies were included covering in total 3822 patients (mean age 45.6 years, 61.9% female). Most studies used educational interventions. Three studies reported on primary outcomes, 12 on secondary outcomes and two on both.Three studies reported improvements in quality of dispensing, interventions led to more intensive symptom assessment (up to 30% more advice given) and a reduction of over-the-counter supply up to 53%. Three studies led to higher consumer satisfaction, effects on adherence from nine studies were mixed (risk difference 0.04 [À0.02, 0.10]). All studies had unclear or high risks of bias across at least one domain, with large heterogeneity between studies.Conclusions: Our review suggests some positive results from pharmacist-led interventions, but the interventions do not seem sufficiently effective as currently implemented. This review should be interpreted as exploratory research, as more high-quality research is needed.

Public knowledge, attitudes, and practices (KAP) regarding antibiotics use and antimicrobial resistance (AMR) in Bangladesh

“…However, our study identified some gaps in knowledge, such as incorrect beliefs about antibiotic resistance stemming from misuse and lack of awareness about the ineffectiveness of antibiotics against viral infections. These findings align with previous research highlighting the persistence of misconceptions and inadequate knowledge among the public [ 33 , 34 ]. Therefore, interventions aiming to improve knowledge should address these specific areas of misconception and provide accurate information about the appropriate use of antibiotics.…”

A systematic literature review of economic evaluation studies of interventions impacting antimicrobial resistance

“…A brief review of the literature of clinical trials conducted for interventions to reduce AMR highlighted numerous interventions that have not yet been the subject of an economic evaluation [68][69][70][71][72]. These included educational and behaviour change interventions to improve prescribing, or to educate patients on their treatment seeking and adherence behaviour, and even interventions to reduce antibiotic use in animals.…”

Clinical Impact of a Pharmacist-Driven Prospective Audit with Intervention and Feedback on the Treatment of Patients with Bloodstream Infection

“…The important role of pharmacists in optimizing the selection and dosage of antimicrobial agents in ASPs has been emphasized [ 5 ]. Several meta-analyses have reported that pharmacist-driven ASPs can lead to a more appropriate prescription of antimicrobial agents [ 18 , 19 , 20 , 21 ]. However, the utility of pharmacist-driven ASPs in patients with BSI remains limited.…”