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Antibiotic and Antimicrobial Resistance (AMR)

Pharmacists intervention in this area includes not only the best dispensing practices, but also information about the importance of taking the antibiotic as prescribed, monitoring and informing patients about possible side effects, adverse reactions and drug interactions.

On the 29th June, the European Commission launched new Action Plan on Antimicrobial Resistance (AMR). According to the Commission in EU alone AMR costs 1.5 billion EUR annually in healthcare costs and lost productivity and threatens achievement of several Sustainable Development Goals. The 2nd Action plan reinforces global EU commitment to tackle AMR and addresses both humans and animals under so called OneHealth approach.

On the same date, the Pharmaceutical Group of the European Union published a Best Practice Paper on antimicrobial resistance entitled “The Community Pharmacist Contribution to Tackling AMR”. With this paper European community pharmacists respond to the European Commission’s call to make the EU a ‘best practice region’.

The paper provides an overview of the activities and services community pharmacists provide across Europe which help address the issue of AMR, as well as several key recommendations:

1. Governments are encouraged to involve community pharmacists in AMR Action Plans developed at a national level,
2. Coordinators of the EU Joint Action on AMR & healthcare acquired infections are encouraged to actively involve community pharmacists in the process,
3. Increased collaboration and communication between community pharmacists, other healthcare professionals, health service providers, regulators, industry, patients and the public is encouraged.

Community pharmacists are often the first and final contact in the health system before a pharmaceutical, a device or another health intervention is supplied. They play pivotal roles in counselling patients and promoting antimicrobial stewardship. They provide preventative action, referral, disposal, treatment in the pharmacy and constantly strive for quality improvements and innovation in pharmacy practice.

Because the use of antibiotics in both human and veterinary medicine is associated with the emergence of resistance, it is crucial that antibiotics are prescribed and dispensed responsibly and used correctly. Non-adherence to antibiotic therapies may result in antibiotic resistance, as suboptimal doses of antibiotic therapy can result in insufficient antibiotic exposure for eradicating infectious bacteria and potentially create an environment that promotes antibiotic resistance. Therefore understanding the correct use of antibiotics and the reasons behind poor adherence to antibiotic therapies (e.g. regimens having several daily doses), is crucial if the developing phenomenon of antibiotic resistance is to be controlled.

Pharmacists intervention in this area includes not only the best dispensing practices, but also information about the importance of taking the antibiotic as prescribed, both in terms of regimen (e.g. every 12h) and extension of treatment (e.g. for 7 days).
Furthermore, by monitoring and informing patients about possible side effects, adverse reactions and drug interactions, pharmacists contribute to the correct use of antibiotics and identify possible causes for non-adherence.

 

European Antibiotics Awareness Day

Since its inception in 2008, PGEU has systematically supported and engaged in the European Centre for Disease Prevention and Control’s (ECDC) European Antibiotic Awareness Day (EAAD) to promote the prudent use of antibiotics. In recent years this has been further enhanced by the use of social media to raise awareness of the issue of AMR and to encourage the prudent use of antibiotics.

PGEU is privileged to be a member of the ECDC’s Technical Advisory Committee (TAC) which meets regularly to provide input into the strategy and materials for EAAD. Recent campaigns have focused on self-medication with antibiotics and from 2013 onwards this has been the focus of campaigns in primary care and community pharmacy.

In 2013-2014 the PGEU actively contributed to the ECDC’s consultation on the development of a toolkit for self-medication of antibiotics in collaboration with the Standing Committee of European Doctors (CPME). This resulted in a suite of materials available in all EU languages which can be adapted as necessary to raise awareness of the dangers of self-medication with antibiotics and their ineffectiveness against colds and seasonal influenza (‘flu).

In 2016 PGEU provided significant input into the ECDC’s EU guidelines on the prudent use of antimicrobials in humans which specifically mentions the role of pharmacists in ensuring the prudent use of antimicrobials.

WHO Europe

In 2014, PGEU collaborated with WHO Europe to survey community pharmacists, other healthcare professionals, government institutions and health service providers to outline the role community pharmacists can play in tackling AMR and encouraging the prudent use of antimicrobials. This collaboration resulted in a report which identifies community pharmacists as important allies in the fight against AMR and that pharmacists already have experience in treating their patients with antibiotics, both responsibly and within the appropriate legal framework.

Additionally, the report concludes that pharmacists are among the best positioned healthcare professionals to facilitate the appropriate use of antibiotics and, therefore, have an essential role to play in tackling AMR alongside policy-makers and general practitioners. PGEU also engages in WHO’s World Antibiotics Awareness Week (WAAW) campaign which complements the ECDC’s EAAD.

Multi-stakeholder Collaboration

PGEU is one of the founding partners of the pan-European interdisciplinary stakeholder collaboration “medsdisposal”. #medsdisposal is a campaign to raise awareness on the appropriate disposal of expired or unused medicines in Europe and includes associations representing European healthcare, industry and student organisations. Crucial to this project’s relevance is an interactive map of Europe with direct links to the official websites providing information on the appropriate way of disposing medicines in each country in the national language(s). In order to increase awareness of this website, social media is used extensively to guide members of the public to the resources on the campaign’s website:

 

In the context of the “One Health” approach, PGEU is a member of the European Platform for the Responsible Use of Medicines in Animals (EPRUMA) core group. EPRUMA is the European association representing veterinarians, farmers and agri-cooperatives, manufacturers of animal medicines and diagnostics, feed manufacturers, professionals working in animal health and sanitary security and professionals working in sustainable agriculture. PGEU, along with other EPRUMA members recently co-signed a declaration on seven commitments for the responsible use of veterinary medicines.