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Empowering pharmacy: Leading the charge against antimicrobial resistance

This World Antimicrobial Awareness Week, Nonyelum Anigbo talks about the role of community pharmacy in combatting increased antimicrobial resistance (AMR)

AMR is posing ongoing threats to the NHS, with primary care services including community pharmacies and GPs being on the frontline of the fight to control and prevent its spread. It is crucial that current and future pharmacists are ready for the long battle ahead of them.

A study published by the Lancet in 2022 found AMR to be a leading cause of death worldwide. The study revealed that in 2019, over 1.27 million people died of AMR – around 3,500 people a day. Meanwhile, over 51,000 people died as a result of AMR in Western Europe, which includes the United Kingdom.

Read more: Pharmacy First to be ‘closely monitored’ for antimicrobial resistance risk

As infections become increasingly challenging to treat due to AMR, more and more NHS resources are required to treat individuals. This is resulting in longer hospital stays, increased risk during routine surgeries and, ultimately, higher death rates. For that reason, it is estimated that AMR will cost the NHS an additional £180 million each year.

So, it is no surprise that tackling AMR is at the forefront of the government’s vision for the future of healthcare in the UK, with the overarching goal being to “contain and control” the spread of AMR by 2040.

In 2019, a five-year plan was launched by the Department of Health  (DH) with three main aims:

  • To optimise the use of antimicrobials

  • To reduce the need for, and unintentional exposure to, antibiotics

  • To support the development of new antimicrobials

This year’s World Antimicrobial Awareness Week theme is "preventing antimicrobial resistance together". According to the government, AMR poses a threat to humans, animals, plants and the environment. Therefore, cross-sectoral collaboration is needed to preserve the effectiveness of antimicrobials and effectively reduce AMR.

Read more: Pharmacy First: Sector must prove it can ‘manage’ antimicrobial stewardship

To achieve this, it is essential that the crucial role pharmacists play in the fight against AMR is understood and supported across the healthcare sector. The role of a pharmacist is constantly evolving, so it is also vital that pharmacists are adapting and developing their skills and expertise to ensure they are being utilised effectively to tackle AMR.

The DH’s five-year plan mentions pharmacists multiple times, highlighting just how crucial it is that pharmacists in primary care encourage antimicrobial stewardship – a program promoting the appropriate use of antimicrobials.

The plan states: “To strengthen stewardship programmes, the UK will…enhance the role of pharmacists in primary care to review the dose and duration of antimicrobial prescriptions (especially long-term or repeat ones) and work with prescribers to review those that are inappropriate through evidence-based, system-wide interventions.”

Read more: How community pharmacy can help Black sickle cell patients

In 2023, NHS England (NHSE) published recommendations for community pharmacy antimicrobial stewardship initiatives, highlighting that 80% of AMR prescribing takes place in primary care, including in GPs, dental practices and other community settings, taken from a UK Health Security Agency (UKHSA) national report.

This puts community pharmacists in a prime position to have a greater influence on the optimisation of antibiotics use. An NHSE report indicated that, currently, many community pharmacy teams are equipped with the right knowledge and training to support this, with the vast majority of pharmacy teams having completed antimicrobial stewardship and infection management e-learning courses.

Another resource that has been increasingly used in community pharmacies is the UKHSA TARGET antibiotic checklist, which is an important tool in personalising advice related to antibiotics and infections for patients and their carers.

In August, the UKHSA published a competency framework that can be used to support the training of prescribers in antimicrobial prescribing and stewardship by assessing their knowledge, skills and competency. Students and trainees could also be assessed using these frameworks to ensure they have met their learning objectives and skills competency.

Throughout the course, students should receive numerous opportunities to practice spotting inappropriately prescribed antibiotics, and complete the TARGET antibiotic checklist with patients, so that by the time they graduate and begin their training year it is like second nature to them.

Professor Diane Ashiru-Oredope, lead pharmacist for healthcare-associated infections (HCAI) and AMR at UKHSA, and deputy chief scientist for the Royal Pharmaceutical Society (RPS), said to me: “Pharmacy teams across all sectors have a pivotal role alongside other health and social care workers to tackle antimicrobial resistance.

“In our recent ESPAUR report, we highlight the strong engagement from community pharmacy teams in implementing antimicrobial stewardship interventions.”

The UKHSA TARGET Antibiotics toolkit has a range of evidenced-based and evaluated resources to support pharmacy professionals working in GP and community pharmacy. The TARGET Antibiotic checklist, for example, can be used to facilitate targeted information sharing between patients and pharmacy teams to address concerns and give appropriate counselling when antibiotics are dispensed to patients.

Read more: BPSA president: I want every member to gain equally from their membership

The RPS provides resources such as the antibiotic amnesty campaigns, to raise awareness that the simple action of returning leftover antimicrobials to pharmacies can help tackle AMR. The RPS Expert Advisory Group on AMR has also recently developed the penicillin allergy checklist to support pharmacy teams in assessing whether a patient is allergic to penicillin or not.

Professor Ashiru-Oredope also told me: “The World Antimicrobial Awareness Week provides a local, national and global opportunity to increase awareness of the challenges that come with AMR and for all to take action.

Our actions protect antimicrobials, everyone can take at least one simple action to contribute to tackling AMR.”

Maria Nasim is acknowledged for comments

Nonyelum Anigbo is the president of the BPSA

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