Community pharmacists—Leaders for antibiotic stewardship in respiratory tract infection

Abstract

Summary What is known and objective Hospital‐based pharmacists are established antibiotic stewards, but the potential for community pharmacists is largely untapped. This commentary explores the potential leadership role of the community pharmacist in antibiotic stewardship using upper respiratory tract infection (URTI) as an example. Comment Community pharmacists are well placed for antibiotic stewardship, possessing the capability (knowledge of medicines), opportunity (contact with prescribers and patients) and inherent commitment. Providing further motivation with information on patient education has great potential to change patient behaviour with respect to consulting a healthcare professional for an antibiotic prescription. A Global Respiratory Infection Partnership pharmacy‐led educational initiative was shown to have a positive impact and can promote appropriate self‐management of URTI and reduce levels of inappropriate antibiotic use. What is new and conclusion Community pharmacists are ideally placed as antibiotic stewards to lead the quest to contain the threat of antibiotic resistance.

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…In the community, there are also ongoing programmes to assess prescribing against agreed guidance given concerns with, for instance, the extent of antibiotic prescribing for URTIs 312 . This includes promoting community pharmacists to help drive ASPs forward to improve the utilization of antibiotics for respiratory tract infections in ambulatory care 159 . Such initiatives are likely to grow to further improve the prescribing of antibiotics in ambulatory care across all sectors, with the South African guidelines regularly updated 250,313 .…”

“…The limited number of physicians in several LMICs, coupled with opportunities for training pharmacists, increases their role in managing most URTIs. As a result, there are increasing calls for community pharmacists to lead local ASPs in ambulatory care to reduce unnecessary prescribing and dispensing of antibiotics 159 .…”

“…GRIP suggest similar activities, including seeking to restrict non-prescription sales of antibiotics, providing data on the scale of the problem, provision of continuing professional development/training where this is currently lacking, outlining the business benefits of patient satisfaction, and the provision of guidelines and patient education material where this does not exist 158,159 .…”

“…As a result, there is a need to ensure good knowledge about antibiotics and AMR development in teaching programs and, for pharmacists and their assistants, regular community practice follow-up post qualification 46,362,369 . Education about ASPs is also important, building on the potential role for pharmacists in leading ASPs in the community in the future having overcome current boundaries and barriers 143,159,314,370 . In addition, increasing the availability of pragmatic guidelines could help pharmacists and their assistants enhance the appropriate management of patients with URTIs 306,364 .…”

“…These include systematic reviews determining possible reasons behind dispensing antibiotics without a prescription 141,155 , patient-related determinants regarding antibiotic use 156 , and reviews assessing the influence of targeted communications among patients to reduce excessive antibiotic use 157 . In addition, initiatives such as GRIP (Global Respiratory Infection Partnership Declaration) help reduce unnecessary antibiotic utilization through recommending non-antibiotic treatments for patients with URTIs 158,159 . However, we believe to date there have not been any publications that have comprehensively focused on all aspects of prescribing and dispensing of antibiotics for URTIs in LMICs, which can be very different to high-income countries with different practices and beliefs.…”