"Stewardship” role for pharmacy in antimicrobial resistance
The UK Government has launched a five-year strategy to slow the spread of antimicrobial resistance (AMR) that aims to improve understanding around the problem, conserve existing treatments and stimulate the development of new antibiotics and diagnostics.
The document, which was widely consulted on, was broadly welcomed by pharmacy groups, which thought pharmacists could play a “stewardship” role on the issue. The strategy will focus on seven key areas (see Panel) and takes into account the annual report of the chief medical officer, published in March 2013, which included a call to action on the issue.
“AMR cannot be eradicated but a multidisciplinary approach involving a wide range of partners will limit the risk of AMR and minimise its impact for health, now and in the future,” said Dame Sally Davies, chief medical officer at the Department of Health, and Nigel Gibbens, chief veterinary officer at the Department for Environment, Food and Rural Affairs.
Kieran Hand, consultant pharmacist for anti-infectives and Royal Pharmaceutical Society spokesman on antibiotics, said the report needed to be implemented immediately if “we are to avoid a future where minor surgery could become life threatening due to infection”.
“Pharmacists have a key role in conserving antibiotics for future generations. Community pharmacists can help patients to manage symptoms of minor infections and support the public with alternatives to antibiotics, including prevention by improving vaccination rates.”
The RPS welcomed the recommendation for antibiotic prescribing and stewardship competences to be included in continuing professional development programmes for health professionals and in undergraduate curricula.
Mike Holden, chief executive of the National Pharmacy Association, said: “Community pharmacy is ideally placed to provide stewardship on this issue and to help educate people on best practice related to the appropriate use of antibiotics.”
The NPA has produced a factsheet to support its members in taking on a stewardship role in tackling AMR. The fact sheet contains advice on ensuring pharmacy practice fits within local and national guidelines, the importance of challenging unnecessary prescribing, advising on self-limiting conditions, managing patient expectations and best practice for patient group directions.
Alastair Buxton, a spokesman for the Pharmaceutical Services Negotiating Committee, said it would like to see the health service acting on the plan to expand the role of community pharmacies, for example, the promotion of pharmacies as a location to treat minor illness as well as the national commissioning of a minor ailment service to provide care at NHS expense to those who would otherwise visit the GP practice. “As part of such a scheme community pharmacies would also be well placed to advise on when antibiotics would not be appropriate for patients with a range of minor conditions.”
Philip Howard, a consultant antimicrobial pharmacist at Leeds Teaching Hospitals NHS Trust, stated that education of the public and health care professionals about antimicrobial resistance was key. “The public need to understand that infection prevention is a key strategy: good hygiene, keeping healthy and getting any recommended vaccines are important.”
The strategy also calls for "exploring how to encourage patients to use community pharmacies for advice". He says: “I feel that having universally available, NHS-funded minor ailment schemes would decrease GP and A&E attendances where antibiotics can be prescribed. In addition, the community pharmacy as another vaccination option would increase uptake rates.”
The strategy also outlines new epidemiological approaches to monitoring antimicrobial consumption in hospitals, and tracking of antimicrobial resistance to usual antibiotic therapy by commonly pathogenic bacteria. There will be £4m made available for research into antimicrobial resistance. Mr Howard added: “This includes antimicrobial stewardship, and I would encourage pharmacists to apply.”
Stephen Whitehead, chief executive of the Association of the British Pharmaceutical Industry, said: “The strategy rightly acknowledges that the commercial environment for antibiotic development needs to be addressed and that a balanced approach to this challenge requires consideration of new clinical development pathways within a flexible regulatory framework alongside appropriate financial incentives.”
The seven areas for future action are:
Source: UK Five year Antimicrobial Resistance Strategy 2013 to 2018
Citation: The Pharmaceutical Journal URI: 11125452
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