AMR: An ever-growing problem

The problem of antimicrobial resistance (AMR) is ever-growing and resolving it is high on the agenda of many international organizations, including the European Commission. They have adopted an action plan against AMR of which the main goals are to make the EU a best practice region and to boost research, development, and innovation. This action plan has resulted in the ‘EU guidelines on the prudent use of antimicrobials in humans’ which targets all actors that are involved in antimicrobial use.

These guidelines describe pharmacists as gatekeepers to the use of antimicrobials. In this role, pharmacists must be a source of advice and information for patients and prescribers on the safe, rational, and effective use of antimicrobials. This encompasses a range of topics in which pharmacists should show their expertise in medicine, including side effects, adherence, interactions and contraindications, storage and disposal and rationale for treatment. The importance of this becomes even more clear when realizing that antimicrobial resistance has been strongly linked to inappropriate use of antimicrobials. As community pharmacists are one of the most accessible healthcare professionals in Primary Care and an important contact point for patients, they could have an important role in improving antibiotic use. Nevertheless, current community pharmacy practice regarding antimicrobials leaves area for improvement. Therefore, pharmacists need appropriate training and guidelines to follow during their practice, and access to sufficient information regarding patient and treatment, for example through more intensive collaboration with prescribers and better communication with patients.

In our review ‘A systematic literature review and meta-analysis of community pharmacist-led interventions to optimise the use of antibiotics’ we have shown that current interventions in the community pharmacy setting have only limited effect on optimizing antibiotic use. Just seventeen studies worldwide have focussed on this topic, showing mixed and unclear results. Consequently, it seems that interventions in the community pharmacy setting should be implemented in novel ways.

Within the HAPPY PATIENT project, we use this knowledge to design and implement multifaceted interventions aimed at pharmacy professionals to improve antibiotic dispensing practices. One of the strengths of the HAPPY PATIENT project is that it is conducted on a large scale in five different countries in the EU: France, Greece, Lithuania, Poland, and Spain. However, this also brings challenges to the project. Dispensing practices and the role of the community pharmacists within the care system vary from country to country.

This is not limited to the types of antibiotics that are dispensed, but also includes differences in collaboration with prescribers, counselling patients, access to information and performing safety checks. Despite these differences, the EU guidelines on prudent use of antimicrobials sketch a single image of the community pharmacist who plays a key role in all these processes. The HAPPY PATIENT project finds a balance between the uniqueness of care systems throughout the EU while taking into account the shared goal for all these countries: optimising the use of antibiotics following EU guidelines.

Maarten Lambert
University of Groningen