Pharmacists Play a Critical Role in Preventing Antimicrobial Resistance

Antibiotic Awareness Week takes place annually in the US from November 18 to 24.¹ The theme for 2024 is “Fighting Antimicrobial Resistance Takes All of Us,” and each day of the week includes a special theme, such as global infection control and patient education.¹ Antimicrobial resistance is considered a global threat. Appropriate antibiotic prescribing and education are key components to prevent resistance, and social media campaigns can play an important part of the community-wide educational component. Pharmacists play a vital role as part of the health care team to prevent antimicrobial resistance through medication therapy management (MTM).

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Antimicrobial Resistance and MTM

The COVID-19 pandemic played a large role in antimicrobial resistance, in part due to an increase in antibiotic usage and prescribing.² Between March 2020 and October 2020, approximately 80% of patients hospitalized with COVID-19 received an antibiotic.² However, antibiotics are not effective against viruses like SARS-CoV-2, and this inappropriate prescribing contributes to superbugs that cannot be treated with antibiotics. Between 2020 and 2021, most adult outpatient antibiotic prescriptions were for azithromycin, which corresponded to peaks in COVID-19 cases.² Antibiotic overuse can also lead to unwanted adverse effects, such as Clostridioides difficile infection. It is estimated that 1 in 5 hospitalized patients who receive an antibiotic experience an adverse drug event.²

Furthermore, many bacterial and fungal infections were undiagnosed and untreated because of fewer health care consults during the height of the pandemic. According to a CDC report, the Antimicrobial Resistance Laboratory Network received and tested 23% fewer culture specimens in 2020 than in 2019.²

Antimicrobial stewardship (AMS) is an important strategy to combat antimicrobial resistance. This involves an evidence-based approach to prescribing and usage of antibiotics.³ The CDC recognizes pharmacists as part of the core elements of outpatient antibiotic stewardship.⁴ Pharmacists are recognized as experts in this area, especially through MTM services. As a critical part of the health care team, pharmacists can improve antibiotic prescribing practices through educational training programs.

The American Society of Health-System Pharmacists (ASHP) and the Society of Infectious Diseases Pharmacists (SIDP) issued a joint statement discussing the pharmacist’s role in AMS,⁵ stating that pharmacists have a critical responsibility to promote AMS. Additionally, it is important to have an interprofessional approach that involves pharmacy leaders and infectious disease (ID) physicians.⁵ Pharmacists can develop AMS guidelines and collaborative practice agreements for their practice site. Additionally, pharmacists can participate in antimicrobial awareness campaigns.

ASHP and SIDP also recommend tracking and reporting antimicrobial use and resistance, which includes collaborating with microbiology staff for antibiogram development. Pharmacists should receive specialized training in ID or AMS.⁵ Examples include a postgraduate year 2 ID residency, ID fellowship with clinical AMS experience, or an AMS certificate program.⁵ Pharmacists should also complete continuing education (CE) programs focused on AMS to stay current with clinical updates. Attending local and national conferences are a great way to complete CE programs and network with other pharmacists involved in AMS.

Like the CDC, ASHP and SIDP recognize pharmacists as AMS champions. Pharmacists can provide education to the health care team, patients, caregivers, and the community,⁵ such as through case based presentations and newsletters. Pharmacists can also serve on local, regional, or national guideline development committees. Collaborating on AMS research projects that include data monitoring can also help prevent antimicrobial resistance and identify patterns. Participating in public health awareness programs on appropriate antibiotic prescribing and the dangers of antimicrobial overuse is also critical.⁵

REFERENCES

1. U.S. Antibiotic Awareness Week (USAAW). CDC. August 9, 2024. Accessed October 2, 2024. https://www.cdc.gov/antimicrobialresistance/communication-resources/usaaw.html

2. CDC. COVID-19: U.S. Impact on Antimicrobial Resistance. 2022. Accessed October 2, 2024. https://www.cdc.gov/antimicrobialresistance/media/pdfs/covid19-impact-report-508.pdf

3. Promoting antimicrobial stewardship to tackle antimicrobial resistance. World Health Organization. Accessed October 2, 2024. https://www.who.int/europe/activities/promoting-antimicrobialstewardship-to-tackle-antimicrobial-resistance

4. Core elements of outpatient antibiotic stewardship. CDC. March 18, 2024. Accessed October 2, 2024. https://www.cdc.gov/antibioticuse/hcp/core-elements/outpatient-antibiotic-stewardship.html

5. Collins CD, Dumkow LE, Kufel WD, Nguyen CT, Wagner JL. ASHP/SIDP joint statement on the pharmacist’s role in antimicrobial stewardship. Am J Health Syst Pharm. 2023;80(21):1577-1581.doi:10.1093/ajhp/zxad164