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How can pharmacists fight antibiotic resistance?

Antibiotic resistance occurs when medicines are no longer effective in treating bacterial infections. This is potentially catastrophic, as much of modern medicine would become impossible without antibiotics.  Simple infections would become life-threatening and common surgery would become unsafe.  Antibiotics are not effective against viral infections, yet they are often used to treat them. Pharmacists are on the frontline of fighting antibiotic resistance, but how can we make a difference in practice?

Recommending symptomatic therapy
• Patients who have viral illnesses, especially respiratory tract infections common in the winter months, need to know the likely duration of the illness and how to self-care, for example drinking plenty of fluids, resting, pain relief and symptom control.

• Such advice has been shown to impact on patients’ perceptions and attitude towards their illness and their perceived need for antibiotics.

• In primary care, pharmacists have also been involved in the development of delayed prescriptions where it is not clear if antibiotics are needed; 70% of patients never return for their prescription.

• Patients who need to be referred to a GP include those at risk of serious complications on account of pre-existing co-morbidity, such as cystic fibrosis, significant heart, lung, renal, liver or neuromuscular disease, those who are immunosuppressed.

Counselling patients on taking antibiotics
A really useful way to remember all the points to cover is the use the mnemonic FRAIS:

F    Finish the course
R    Regular intervals (e.g. 6-hourly, 8-hourly, etc)
A    After, with or before food
I     Interactions
S    Side-effects

Talk about adverse effects
• Antibiotics can cause side-effects such as severe diarrhoea, thrush and rashes.  It’s important patients have a realistic view of what to expect and are given strategies to cope with these, including returning for further advice.

Tell patients about antibiotic resistance
• Making it clear to patients that their individual actions are important can make a difference to behaviour.

• Explain that non-adherence to antibiotics can result in the infection becoming drug-resistant, as suboptimal doses can result in insufficient amounts present in the body to eradicate bacteria. Simple advice around regular hand-washing and keeping any vaccinations up to date is also important in preventing infections in the first place.

• There are lots of online resources from Public Health England to support pharmacists in raising awareness of antibiotic resistance.  You can also find out more about RPS work on this topic here.

Professor Jayne Lawrence
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