Reducing antibiotic resistance by establishing pharmacist-prescriber networks

Taking antibiotics when we do not need them can cause bacteria in our body to change and become resistant to drugs. This means that at a certain point, bacteria in our body become antibiotic resistant and cannot be effectively killed by antibiotics.

Overprescribing of antibiotics is one of the main risks for developing an antibiotic-resistant infection. Most antibiotics (80%) are prescribed in the community for common infections like respiratory tract infections (typical coughs, sore throat and earache).

The more antibiotics are used to treat common infections such as a sore throat, the more likely they will become ineffective for treating conditions that are more serious. Antibiotic-resistant infections mean longer hospital stays, rising healthcare costs and a greater chance of dying.

South Africa’s high burden of infection forms its greatest disease burden. This poses a threat for the country to achieve Sustainable Development Goal (SDG) 3, Good Health & Wellbeing, but also affecting its ability to attain other SDGs. In an era of antibiotic resistance, it is critical that patients receive the right antibiotic at the right time with the least harm to present and future patients.

Antimicrobial stewardship programmes have been implemented in hospitals across South Africa and help clinicians reduce overuse and misuse of antibiotics, without affecting patient outcomes. This typically involves educational programmes, the implementation of evidence-based guidelines and audit and feedback for prescribers.

However, such efforts have largely been implemented in hospitals rather than in community settings- where most antibiotics are prescribed. To overcome this problem, Renier Coetzee, a pharmacist at the School of Pharmacy, University of the Western Cape, and Oliver van Hecke, a GP and Postdoc Researcher at the University of Oxford are trying to establish a pharmacist-prescriber network in the region.

The aim of the network is to promote evidence-based antibiotic prescribing through a multidisciplinary team or network of doctors, nurses and pharmacists working in in publicly-funded primary care clinics in the greater Cape Metro region, South Africa. The Cape Metro is a peri-urban region around Cape Town of just over 290km. It includes the townships of Khayelitsha and Mitchells Plain with an estimated population of over four million people. The unemployment rate in the area is 30%, with a substantial proportion of households earning less than < £240 (R4800) per annum, and 20% living in informal dwellings. Access to primary care health services is free of charge.

Pharmacists can play an active role in improving the appropriateness of antibiotic prescribing by providing expert advice and raising awareness of guideline-adherence and policy-guided antibiotic prescribing.

“Evidence from high-income countries, suggests pharmacist-prescriber network improves the quality of antibiotic prescribing. However, we were also acutely aware that evidence from one setting is not necessarily transferable to another. By running a workshop with local pharmacists, doctors, nurses working in the community, this exchange has identified areas where and how such a pharmacist-prescriber intervention might work to optimise antibiotic use.”

The AfOx travel grant supported Oliver to travel to South Africa to collaborate with Renier. Together, they held an informative workshop with local pharmacists, doctors and nurses working in the community to see where and how such a pharmacist-prescriber intervention might work to optimise antibiotic prescribing.

One of the ideas stemming from this workshop was for pharmacists to comment and feedback on the appropriateness of antibiotic prescribing (concordant with prescribing guidance). This was felt would encourage pharmacists to be more actively involved in antibiotic stewardship measures, instead of the more passive activity of dispensing medication. Renier and Oliver are now applying for further funding to develop some of these ideas.

Renier and Oliver have published their findings in the AOSIS journal, available to read via this link: https://safpj.co.za/index.php/safpj/article/view/5090