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Antibiotic stewardship an
BY JOHN BELL FPS
Pharmacists have a critical role to play in ensuring the responsible use
of antibiotics. This was the clear message to come from the 76th annual
Congress of the International Pharmaceutical Federation held last month in
A roundtable meeting aimed at addressing
the issue of antibiotic resistance was
moderated by the Royal Pharmaceutical
Society (RPS) CEO, Helen Gordon. Panel
members included Eduardo Savio (an FIP
Vice President) from Uruguay, Jose Luis
Castro (Regional Advisor on the Rational
Use of Medicines to the Pan American
Health Organization), Per Troein (Vice
President, Strategic Alliances, IMS Health)
from Sweden and Sabiha Essack (Research
Chair in Antibiotic Resistance at the
University of Kwazulu-Natal), South Africa.
FIP adopted its first statement on
antimicrobial resistance in 2008. Since
then there has been greater awareness
of the problem and new concerns have
been expressed by the scientific and
health care communities.
More recently, organisations such
as WHO and the European and US
Centers for Disease Control (CDC) have
issued global action plans. Following
submissions from both PSA and the RPS,
in November last year the FIP published
Fighting antimicrobial resistance:
The contribution of pharmacists.
This 40-page document provides a
comprehensive overview of pharmacists'
activities worldwide and offers a menu
of solutions to the AMR problem
ranging from recommending and
administering influenza vaccine to
responsible prescribing by pharmacists
of trimethoprim for UTIs and pharmacist
coordinated stewardship programs in
hospitals. Acknowledgement is given
in the document to PSA, SHPA and NPS
programs in Australia.
The Roundtable panel raised a number
of issues including the widespread --
arguably quite inappropriate -- use of
antibiotics in veterinary medicine
and animal husbandry, the dearth
of development of new classes
of antibiotics and the challenge
to achieve behaviour change in
healthcare practitioners and consumers.
Furthermore, in some countries the
regulatory framework is inadequate and
allows antibiotics to be sold (legally or
illegally) without prescription.
Mr Castro indicated that this was a
particular problem in parts of Africa, Asia
and the Americas and national pharmacy
associations had an important role to play
in establishing appropriate policies and
ensuring these policies were translated
into practice. There needed to be a
greater strengthening of monitoring and
enforcement procedures, he said.
Professor Essack noted that pharmacists,
often the first and last point of
contact with patients, were frontline
communicators on the rational use of all
medicines and should be proactive in
influencing prescribing practice.
Professor Essack, a member of the Global
Respiratory Infection Partnership (www.
grip-initiative.org) referred to the GRIP
5P (Pentagonal) Framework which states
success in antibiotic stewardship must
involve effective policies, prevention
strategies and collaboration amongst
prescribers, pharmacists and patients.
During discussion she added a new
dimension: the seven Ds. These were,
she explained, the correct diagnosis,
choice of the right drug, the most suitable
dose form (e.g. IV or oral), the actual
dose (according to pharmacokinetics
and dynamics), dose interval (to ensure
adequate blood levels), the dose
duration, and importantly, dialogue with
the patient to maximise understanding of
the treatment and adherence.
FIP heads back north
Following just four trips south of the
equator in over 100 years -- Sydney in
1988 and 2003, Salvador, Brazil in 2006
and this year in Buenos Aires -- next year
the FIP Congress will be held in Seoul,
South Korea, 10--14 September. The
theme will be Medicines and beyond; new
ways for pharmacy to provide more than
just medicines. In 2018 the FIP Congress
location will be Glasgow; and in 2019,
ˆ Prosper Hiag, President of the Cameroon Order of Pharmacists and Ivan Kotze,
CEO of the Pharmaceutical Society of South Africa with John Bell.
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