Community Pharmacy Antimicrobial Stewardship
U.S. Antibiotic Awareness Week is November 18th-24th. During this observance, SIDP is highlighting members who promote optimal antibiotic use and combat the threat of antibiotic resistance in impactful and innovative ways. This blog features Dr. Emily Wetherholt and her role as a community pharmacist and an antibiotic steward.
Briefly describe your daily antimicrobial stewardship practices
As a community pharmacist, it is my job to ensure that each patient gets the right drug, at the right dose, at the right time. I focus my attention on the workhorse of children’s antibiotics, amoxicillin suspension, due to a large propensity for error. 'I've seen many errors related to incorrect prescribing, including selection of the wrong concentration requiring children to receive unnecessarily large volumes that are difficult to take or the use of weight-based dosing alone without regard for the maximum dose limits. This year, dispensing has been further complicated by drug shortages on various concentrations. This has led to further interventions to try to preserve the supply for those who need it most, such as recommending a capsule or chewable tablet instead of the suspension for a 13-year-old. I also counsel on the appropriate use of antibiotics, including potential drug interactions and how medications should be stored. Additionally, all community pharmacists promote and administer vaccines, especially the pneumococcal vaccine, to help decrease the number of antibiotics needed. I also dispel any myths related to vaccines, such as “the flu shot can make you sick”.
What stewardship initiative or antibiotic awareness effort are you most proud of that you have participated in or led?
As a community pharmacist, I do not currently have access to an electronic health record (EHR), thereby limiting my ability to know the indication for the antibiotic prescription. However, I am able to double-check appropriateness using other context clues, such as discrepancies between the dosage form and the administration instructions. For example, when nitrofurantoin macrocrystals are chosen twice daily but should be dosed four times daily. Correcting misuse or concentration of dosage form is another task I perform regularly. As a mom of four, I know the struggle to give children antibiotics, so I regularly suggest concentrations for liquid formulations that will help reduce the volume of administration (e.g., changing 30 milliliters (1 ounce) of a certain concentration to a different concentration that requires only 9 mL). A single call to the prescriber is usually able to rectify any issues.
What does “Being Antibiotics Aware” mean to you?
“Being Antibiotics Aware” as a community pharmacist means knowing when to refer a patient to a provider to obtain antibiotics and when supportive care for symptoms is sufficient. Not every case of the sniffles needs to be treated, even if it is green. In fact, more often than not, it is a virus, and therefore antibiotics are not going to help anyway.
What is one pearl you have for all clinicians to help them be antibiotic stewards?
My clinical pearl for clinicians is to make the time to include the patient as part of the care team. Patient education is one of our most underused tools in terms of antibiotic stewardship. Patients know when they are sick that medications make them feel better. They come to providers for our clinical expertise, and it is up to us to explain when they are not a candidate for antibiotics.
Emily Wetherholt PharmD, BCACP
Hanover Park, IL