The Pharmaceutical Journal
Vol 278 No 7458 p773
30 June 2007

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• Veterinary pharmacy
• Antibiotic resistance
• Community pharmacy
• Opiate addiction
• Clinical trials
• Retention fees (3)

Letters to the Editor

Antibiotic resistance

Specialist role of microbiology pharmacist

From Dr P. Long

In the UK, some 20 per cent of all prescriptions for antibiotics are dispensed through hospital pharmacies. About one third of in-patients receive antibiotics at some point during their stay, but up to 50 per cent of these prescriptions may be inappropriate or unnecessary and at a huge cost to the taxpayer. Common prescription errors include improper dose or formulation, using a drug that is more expensive than an equivalent alternative, duplication of drug therapy, or use of a drug not fit for purpose.

Additional factors that may contribute to inappropriate use include patient expectations, clinician inexperience or diagnostic uncertainty, and an increased tendency to practise defensive medicine due to constraints in consultation time. Misuse of antibiotics is widely recognised as a major contributing factor to the emergence of drug-resistant microbes. Resistance to antibiotics makes infections more difficult and expensive to treat, increasing the likelihood of complications and the length of hospital stay.

In response to the World Health Organization, the European Union and recommendations from the 1998 House of Lords Science and Technology Select Committee report “Resistance to antibiotics and other antimicrobial agents”, the Department of Health issued guidelines with the core aim of decreasing the emergence and spread of antimicrobial drug resistance and its impact on the treatment of infection. The action plan outlined eight areas, among which were strategies to monitor and optimise prudent antimicrobial use. In 2003, the DoH allocated funds of £12m to acute NHS trusts to extend clinical pharmacy services to areas of antibiotic use, thus the role a microbiology pharmacist was formally created.

To date, over 140 pharmacists across 130 NHS trusts have been appointed, each with a strong background in infectious disease and antimicrobial management. In addition to auditing local antibiotic use, the microbiology pharmacist may also take on additional roles including counselling other health care professionals in best practice for antibiotic prescribing and infection control, formulary developments and appraisal of new antimicrobials to improve clinical management guidelines.

Overseas studies have shown an apparent overall health care benefit to patients after the introduction of pharmacy-led programmes, including a reduction in drug tariffs. Unfortunately, this seems not yet to be the case in the UK where the current role of the microbiology pharmacist in promoting prudent and responsible antibiotic prescribing has been seen from some quarters as a corrective measure to reduce overall costs rather than an active contribution to patient care.

Prescribing control systems support sensible antibiotic use and facilitate a better understanding of the roles different health care providers contribute towards improving patient care. The key components for successful management of antimicrobial use are the formulation, implementation, surveillance and update of antibiotic policies that are based on the local epidemiology of both prescribing and antimicrobial resistance patterns.

With the introduction of supplementary prescribing and the evolution of the consultant pharmacist grade within the NHS, microbiology pharmacists should be able to make evidence-based decisions to modify or stop “inappropriate” dispensing, without prior reference to the clinical team, albeit within the remits of stringent guidelines. This will lead the way for career development of an independent microbiology pharmacist who is involved in all aspects of infection control.

Undergraduate curricula will have to develop to reflect the rigorous life-long learning skills required of tomorrow’s pharmacists to fulfil the evermore demanding and challenging aspects of this specialist role.

Paul Long
Senior Lecturer in Molecular Microbiology
School of Pharmacy,
University of London

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