Pharmacies

At the outpatient pharmacy, patients may seek antibiotics for treating bacterial infections. Pharmacists play an important role in ensuring that patients receive the prescribed medicines, do not have a history of drug allergies to the medication, and are properly educated about the appropriate way to take the antibiotic course. In too many countries, however, antibiotics can be obtained over the counter without prescription. Pharmacists dispense antibiotics, but sometimes, the full antibiotic course dispensed for treatment might not be affordable to the patient. Problems of stockouts or substandard or falsified antibiotics can also create problems. Some pharmacy outlets might be in the informal sector and not be compliant with licensing or other regulations. Financial incentives may favor dispensing of brand-name antibiotics when lower-cost generics might be available. Packaging of antibiotics might be broken when partial courses of antibiotics are dispensed, and patient instructions and warning labels on the packaging might be missed.

Challenges include:

  • Dispensing without a healthcare provider’s prescription
  • Stockouts
  • Substandard or falsified antibiotics
  • Financial incentives influencing dispensing of brand-name vs. generic antibiotics
  • Pharmacies operating outside the formal sector
  • Need for effective packaging, warning labels and patient instructions

Background Literature

Multiple studies document the knowledge, attitudes and practices of community pharmacists towards antimicrobial stewardship (e.g., in Malaysia and Pakistan).

Pharmacists can play an important role in enabling more appropriate use of antimicrobials and providing education to both patients and providers in support of this goal. [Sakeena MHF, Bennett AA, McLachlan AJ. Enhancing pharmacists’ role in developing countries to overcome the challenge of antimicrobial resistance: a narrative review. Antimicrob Resist Infect Control, 2018; 7:63. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29744044]

With the introduction of electronic systems to capture data and mobile technologies to share such data, new opportunities for engaging pharmacists more deeply in antimicrobial stewardship have surfaced [Gilchrist M, Wade P, Ashiru-Oredope D, Howard P, Sneddon J, Whitney L, Wickens H. Antimicrobial Stewardship from Policy to Practice: Experiences from UK Antimicrobial Pharmacists. Infect Dis Ther 2015; 4(Suppl1):51-64. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569645/pdf/40121_2015_Article_80.pdf]

Current Efforts

Providing an alternative to small retail drug shops, a program in Tanzania has supported accredited drug dispensing outlets (ADDOs) with “extensive training, business incentives, authorization to dispense a limited list of antimicrobials and other medicines to treat common conditions, regulatory enforcement of practice standards, and efforts to affect customer demand.” The role of ADDOs in ensuring improved access to antimicrobials has been studied. [Chalker JC, Vialle-Valentin C, Liana J, Mbwasi R, Semali IA, Kihiyo B, et al. What roles do accredited drug dispensing outlets in Tanzania play in facilitating access to antimicrobials? Results of a multi-method analysis. Antimicrob Resist Infect Control 2015; 4:33. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4545914/pdf/13756_2015_Article_75.pdf]

Several companies (e.g., PharmaSecure, Sproxil, and mPedigree) are providing authentication of drug packages, from pharmaceutical manufacturing plant to pharmacy outlet, and these can help address the challenge of substandard and falsified antibiotics.

Opportunities for Innovation

—Could pharmacy-based approaches to support better dispensing practices of antimicrobials build upon the experience of accredited drug dispensing outlets?

—Could community pharmacist efforts to engage in health education and disease prevention be extended to improving antibiotic use?

—Could other data, from prescribing to medication adherence to antimicrobials, be derived from authentication systems of drug packages?