Of all the medications that pharmacists dispense, antibiotics are one of the most important 一 but often, one of the most dangerous.

Every year, over 150 million antibiotics are prescribed, but nearly 1/3 of them are unnecessary. When patients take antibiotics they don’t need, they can experience a number of consequences, ranging from mild side effects to severe allergic reactions.

In fact, complications related to antibiotics account for over 140,000 emergency department visits and cost the US healthcare system millions of dollars annually.

Long-term, unnecessary antibiotic use can lead to antibiotic resistance, which leaves patients prone to infection and unresponsive to treatment. The impacts are significant.

The World Health Organization (WHO) reports, “Antibiotic resistance is rising to dangerously high levels in all parts of the world. New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases. A growing list of infections 一 such as pneumonia, tuberculosis, blood poisoning, gonorrhea, and foodborne diseases 一 are becoming harder, and sometimes impossible, to treat as antibiotics become less effective.”

With less effective treatments, patients are susceptible to chronic health conditions, complications, and even death.

With antibiotic resistance on the rise, it is the responsibility of healthcare professionals, pharmacists included, to make a change. Enter the world of antibiotic stewardship. 

According to the CDC, antibiotic stewardship is “the effort to measure and improve how antibiotics are prescribed… to effectively treat infections, prevent patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance.”

As the most accessible healthcare providers, pharmacists have the ability to mitigate potentially harmful antibiotic use and improve health outcomes across the board. Learn how you can get involved and become an antibiotic steward in your community.

Collaborate with Providers

The key focus of antibiotic stewardship is making prescribing more safe and effective. As a pharmacist, although you are not responsible for writing prescriptions, you can keep in close contact with those who are and ensure that they follow the right protocols. When you work with primary care providers, communicate your focus on proper antibiotic use 一 specifically, that antibiotics are only prescribed when necessary and in accordance with the right guidelines.

When you receive a prescription, take the time to review it carefully, particularly the dosage and duration, and confirm that CDC recommendations are being followed. Along the way, consult the provider with any issues that come up. The next time you work with a  provider, try a few practices to promote antibiotic stewardship:

  • Encourage providers to include diagnoses or ICD-10 codes on prescriptions to verify appropriate agent, dose, and duration
  • Ask providers to include weight on pediatric prescriptions to verify dosing
  • Verify antibiotic duration if it appears to be excessive
  • Notify the provider if antibiotic appears to be redundant in spectrum coverage
  • Ask for indications for antibiotic refills
  • Suggest alternatives when evidence-based treatment is not ordered
  • Track all antibiotic prescriptions within the PioneerRx Pharmacy Software System

Educate Your Patients

In addition to working with providers, you can also work with patients to increase antibiotic awareness. Pharmacies are education hubs for their communities, and your patients look to you to give them the most up-to-date health information. This includes educating them on the latest data, trends, and recommendations for antibiotic usage.

You can provide education both in your entire pharmacy and on a patient-to-patient basis. On a larger scale, offer patients the resources and promotional material they need to learn about antibiotics, including their benefits and potential risks. The CDC has a number of print materials (including handouts, posters, and counter clings), video and audio clips, and infographics that you can take advantage of and display in your pharmacy or online. To take it a step further, try offering an antibiotic education class for patients looking to learn more.

To make your approach more personal, meet with patients who were recently prescribed an antibiotic and teach them how to take it properly. Conversations can center around the difference between viral and bacterial infections, how to discuss treatment options with providers, and how eliminating unnecessary antibiotics can reduce the chance of antibiotic resistance. No matter where the conversation leads you, leave room to answer questions and address potential concerns that may come up.

Intervene with Clinical Services

Aside from counseling patients, your pharmacy can offer a number of clinical services that promote antibiotic stewardship. In addition to improving antibiotic usage, these services can give you the opportunity to expand your scope of care and generate extra income.

First, offer vaccinations. A key part of decreasing antibiotic resistance and the complications that come from them is getting to the root of the problem: infectious diseases. Many infectious diseases, like tetanus, tuberculosis, and meningitis, are preventable with vaccines 一 and eliminate the risk of patients needing antibiotics to recover. Vaccinating for standard bacterial infections can also open up the door to vaccinate for other illnesses, like COVID-19.

Second, promote point-of-care testing. By testing for common illnesses like cold and flu, you can determine the source of a patient’s symptoms and decide whether or not antibiotics are necessary. In the process, you can eliminate unnecessary antibiotic intake and make sure that patients are given the right treatment plan.

Third, when you determine that antibiotics are appropriate, offer your patients a comprehensive medication therapy management (MTM) program. MTM differs from standard patient counseling because it allows you to create a personalized treatment plan for each patient, which is accompanied by frequent check-ins and follow-ups.

MTM programs are particularly important for patients with chronic conditions, like recurrent urinary tract infections (UTIs) and some sexually transmitted diseases (STDs). With a comprehensive MTM program set in place, you can minimize the dangers of prolonged antibiotic use.

Become an Antibiotic Steward

Antibiotics are one of the greatest feats of modern medicine.

When they are taken incorrectly, though, they can pose serious threats. As a pharmacist, you have the opportunity to educate providers and patients about proper antibiotic prescribing and usage ㅡand decrease the dangers that surround them.

By integrating a few simple steps into your pharmacy’s workflow, you can become an antibiotic steward and see better health outcomes in your community.

Additional Resources

CDC “Be Antibiotics Aware”

HQI Community Pharmacy Antibiotic Stewardship Toolkit

Infectious Diseases Society of America (IDSA) Practice Guidelines

Johns Hopkins Antibiotics Guide

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