Are We Making the Most of Community Pharmacies? Implementation of Antimicrobial Stewardship Measures in Community Pharmacies: A Narrative Review

Abstract

Community pharmacists recognize the need to implement antimicrobial stewardship activities in community pharmacies. They are in a unique position to provide triage for common primary care indications and to lower the burden of patients at general practitioners’ offices. However, research shows that, in some areas, dispensing of antimicrobials without valid prescription is still highly prevalent. Regardless of training, every community pharmacist can give his contribution to antimicrobial stewardship. One of the basic elements should be antimicrobial dispensing according to regulations, either prescription only, or according to guidelines where pharmacists have prescribing authority. Patient consultation supported with educational materials, such as leaflets, may reduce patients’ expectations to receive antibiotics for self-limiting infections and reduce pressure on general practitioners to prescribe antibiotics on patients’ demand. Treatment optimization may be achieved in collaboration with the prescribing general practitioners or by providing feedback. At last, pharmacists provided with additional training may be encouraged to provide consultation services to long-term care facilities, to introduce point-of-care testing for infectious diseases in their pharmacies or prescribe antimicrobials for uncomplicated infections. These services are welcomed by patients and communities. Expanding pharmacy services and pharmacists’ prescribing autonomy have shown a positive impact by reducing antibiotics consumption, thus ensuring better compliance with treatment guidelines.

Antimicrobial Resistance and Community Pharmacists’ Perspective in Thailand: A Mixed Methods Survey Using Appreciative Inquiry Theory

“…The survey results suggest that antibiotic stewardship resources strongly relate to the positive attitudes of pharmacists for rational antibiotic dispensing practices. The present results and previous studies demonstrated that the fight against AMR in community pharmacies might play within the limits of environmental work contexts to support ASU [ 25 , 58 , 59 , 60 , 61 ]. The concern for most community pharmacists was the lack of available materials, resources, surveillance systems, and infrastructure-supported collaboration with other healthcare providers for providing AMR practice [ 62 ].…”

Pharmacists knowledge, perception and practice regarding medication disposal

“…Improper disposal of antibiotics is considered an overlooked source of increased antimicrobial resistance, 18 but only 45.2% of Trinidadian pharmacists were aware of this risk. With the spread of antibiotic stewardship programmes in community pharmacies, 19 there is a need to include proper disposal methods of antibiotics to mitigate this effect. Although antibiotics disposed of in the trash may be acceptable if there is no medication take-back programme, it will eventually leech into the environment, which highlights the need for implementation of a drug takeback programme.…”

Developing a Tool for Auditing the Quality of Antibiotic Dispensing in Community Pharmacies: A Pilot Study

“…Community pharmacists are in a unique position to positively impact antibiotic use and reduce antimicrobial resistance [ 1 , 2 ]. The European Centre for Disease Prevention and Control (ECDC) has established guidelines for the prudent use of antimicrobials for human consumption, explicitly stating that community pharmacists are gatekeepers to antibiotic use [ 3 ].…”