International Stewardship: Antibiotic Awareness Across the Globe

Your daily role as an antimicrobial stewardship pharmacist: An "Antibiotic Guardian".

A key clinical and research focus of CIDR, is pediatric care and pediatric infectious diseases. As a Pediatric Pharmacy Advocate, I have a major role to play in promoting rational use of antibiotics in neonates and pediatric patients: Pediatricians and Neonatologists even call me “Antibiotic Guardian”. During daily rounds with medical teams, I always remind them to reassess antibiotic therapy by asking four essential questions:

1. Does my patient really need this antibiotic?
2. Are we using the most targeted agent?
3. Is dosing regimen appropriate for indication?
4. For how long should we give therapy?

By asking these questions, I am able to perform several interventions related to de-escalation based on cultures results, discontinuation of inappropriate duplication, dose adjustments and short duration of therapy.

What international stewardship initiative or antibiotic awareness effort are you most proud of that you have participated in or led?

AUBMC has a NICU with 21 beds and a pediatric ward, serving 35 medico-surgical patients, especially in pediatric cardiology and oncology. Antibiotic resistance is a difficult issue we face; we’ve seen a continuous rise in CRE rates in our pediatric population. Since 2017, I took over the pharmacy leadership role in the NICU specific antimicrobial stewardship program (ASP). Our team succeeded in decreasing Antibiotic Usage rate (AUR) by 43% in one year. In 2019, I collaborated with ASP Pharmacist in the carbapenem sparing strategy through daily prospective audit, intervention and feedback on all carbapenem therapy in pediatric and neonatal patients. This strategy was proven effective in optimizing appropriate carbapenem use.

Being a team leader, I always instruct and guide my team members to be Antibiotic advocates in pediatric patients especially because antibiotics are among the most used class of drugs in this population. Antibiotic Stewardship should be a shared responsibility of the whole healthcare team; our interventions as drug experts can make a big difference for rational antibiotic prescribing.

What actions can pharmacists take to optimize antibiotic use across the globe?

One of our essential roles as pharmacists is to be “Medication Guardians”, especially for antibiotics; being the most accessible class of drugs. I urge all clinical pharmacists to be antibiotic stewards and ask before dispensing: “Does the patient need this antibiotic?”

What does "Being Antibiotics Aware" mean to you?

Being Antibiotic Aware means for me to be “Smart in Antibiotic Use”: choose the right antibiotic for the right patient at the right dose and for the right duration of therapy.

What is one pearl you have for all clinical pharmacists to help them be antibiotic stewards?

Optimization, not minimization, of therapy is the ultimate goal of Antimicrobial Stewardship. Through daily review, analysis and intervention within the multidisciplinary team, pharmacists are able to spare patients, especially pediatrics and neonates, antibiotic abuse and misuse.

Therese Saad, PharmD, BCPS, BCPPS

Pediatric Clinical Pharmacy Specialist and Pediatric Pharmacy Team Lead 

American University of Beirut Medical Center (AUBMC), Beirut, Lebanon