THE International Pharmaceutical Federation (FIP), a global non-governmental organisation with four million members comprising pharmacists and pharmaceutical scientists, set aside October 28, 2022 to focus on antimicrobial stewardship (AMS).
Antimicrobial stewardship is the vigilant and accountable management of agents used to treat suspected microbes (fungi, bacteria, viruses, and parasites) that invade and infect hosts, either humans, animals or plants. Antimicrobial agents include antivirals, antifungals, antibacterials/antibiotics, antiparasitics, biocides and disinfectants.
The question is, why is there such an emphasis to monitor how these antimicrobials are consumed? The answer lies in your imagination of the world before penicillin (first antibiotic) was discovered in 1928, when mankind was threatened by plagues with no line of defence at hand.
Although we currently have a selection of antibiotics from various classes and levels from first generation to fourth generation, no novel antibiotic has been released. So, the pool of reserves is restricted. This is the treatment challenge facing healthcare professionals, to effectively fight established and emerging infections, in spite of resistance to antimicrobial agents.
Antimicrobial resistance (AMR) is caused by the misuse and overuse of antimicrobials, where the microbes change over time and no longer respond to the drugs. We have witnessed the challenges of dealing with the variant forms of the COVID-19 virus (alpha, beta, gamma, delta, omicron and sub-variant BA.2). These new drug-resistant pathogens which emerge, make it near to impossible to treat patients and curb the spread of infections.
The direct and indirect consequences of AMR are exorbitant individual and national costs for higher levels antimicrobials, prolonged hospitalisation, disability and, in worst-case scenarios, death.
FIP partnered with the lead organisation, the World Health Organisation (WHO), since pharmacists are strategically placed to champion the fight against AMR, which is considered one of the top 10 global public health threats against humanity. The FIP not only focused on policy and advocacy, but also sent strong signals to the global ministerial meeting, indicating that 144 countries had a national action plan to address AMR.
Centers for Disease Control and Prevention (CDC) indicated that more than half of the antibiotics prescribed in hospitals were inconsistent with the recommended prescribing practices. The following stats released by CDC show unjustified prescriptions in the following:
> 79 per cent in community-acquired pneumonia
> 77 per cent of patients with urinary tract infections
> 47 per cent of patients who were prescribed fluoroquinolone
> 27 per cent of patients prescribed vancomycin injection, the last-resort drug
From the practical toolkit done by WHO in 2019 for low- and middle-income countries, the following basic antimicrobial stewardship (AMS) interventions were recommended, building on the existing limited healthcare infrastructural system:
> Education of the involved healthcare workers (prescribers, pharmacists and nurses)
> Design a standardised record system to view all patient medications
> Review rationalisation of treatment prescribed against documented indications
> Review treatment prescribed for patients with three or more broad-spectrum antibiotics
> Review dosage of treatment
> Review surgical prophylaxis treatments either as single dose or for a 24-hour period
> Develop and implement standard treatment guidelines for common conditions such as community-acquired pneumonia, urinary tract infections, skin and soft-tissue infection, surgical prophylaxis and catheter-related infections
> Identify leadership and expertise in infection management
> Establish a drug and therapeutics committee and ensure continuous availability of essential antibiotics through a robust supply-chain management
> Establish basic microbiology laboratory facilities
> Regular surveillance of AMR, AMC and healthcare facilities and hospital-acquired infections
If AMS intervention is already established, then continuous quality improvements are monitored by:
> Setting SMART goals in changing how antibiotics are consumed which are specific, measurable, achievable, relevant and time-bound.
> Establishing a measurement matrix
> Identifying behavioural changes that will be transformative in AMS
AMS must be a coordinated programme and designed to meet the need of the citizenry in their unique situations, whether constrained by geographical or economic factors. Hence, the framework must have a practical approach, taking into consideration those rare scenarios that might occur.
Antimicrobial stewardship is a tall order and requires a concerted effort from all stakeholders such as the general public, the healthcare professionals, professional associations and councils, the governing entities such as the Food and Drugs Department (FDD) as well as the national and international policy makers.

For further discussion, contact the pharmacist of Medicine Express PHARMACY located at 223 Camp Street, between Lamaha and New Market Streets. If you have any queries, comments or further information on the above topic kindly forward them to medicine.express@gmail.com or send them to 223 Camp Street, N/burg. Tel #225-5142.