Planning for the future

The pharmacy is where people come for information and advice, and is where they get prescription and non-prescription therapies, said Mr John Bell, Principal Advisor to the Pharmaceutical Society of Australia Pharmacy Self Care Programme and Practitioner/Teacher in Primary Health Care at the Graduate School of Health, University of Technology Sydney.

However, there is increasing awareness of antibiotic stewardship in the community: in general, people do appear to have a greater awareness of AMR. They have often heard about “good” and “bad” bacteria and are aware of the importance of maintaining a healthy microbiome. Yet when it comes to the individual, people will tend to regard their need for antibiotics as more important than anyone else, said Mr Bell.

"Patients want antibiotics due to a variety of misconceptions. They think they’re cost effective, believe that they’re going to work quickly to help them recover fast from cold and flu and think they will reduce risk of serious illness"

Mr John Bell

There are many potential impediments that explain why pharmacists are often unable to effectively convey the importance of appropriate antibiotic use to patients. It may be that the pharmacist doesn’t have sufficient understanding of RTIs. They may be unwilling to go against the doctors’ recommendations and may not believe that it is appropriate to disagree with what the doctor has decided. There may be financial disincentives where pharmacists believe they can better sustain their businesses by dispensing prescriptions rather than providing more appropriate recommendations.

They may feel that they are not getting sufficient advice or support from the local, national or international organisations. This is all compounded by the fact that, just like medical practitioners and other healthcare professionals, they feel they do not have the time to spend an extra minute or two talking with each patient.

There are several reasons why patients continue to believe that they need antibiotics. In a 2014 survey on behalf of the Longitude Prize, it was found that one in two (49%) of GPs prescribe antibiotics once a week or more without knowing whether they are medically necessary, and 44% of GPs have prescribed antibiotics just to get a patient to leave the surgery. There is the unnecessary postdating of prescriptions, and the promotion of non-prescription products as containing antibacterials and/or antiseptic ingredients.

In order to turn these challenges into opportunities, it is important to ensure pharmacists are trained in antibiotic stewardship and are aware of AMR. There are potential financial advantages for both patients and pharmacists in using treatments other than an antibiotic.

Pharmacists need to make sure they provide patients with realistic expectations about the duration and severity of symptoms. Pharmacists can recommend evidence-based products to treat the most problematic and most troublesome symptoms, whilst allowing for personal preferences. Sore throat is often the most prominent first symptom that occurs with an upper respiratory tract infection, so it is important to treat the inflammation associated with this symptom.