steps to enhance the national capacity to tackle substandard and falsified medicines .
Dr Khalid Eljaaly ( King Abdulaziz University , Saudi Arabia ) described how a prescription-only dispensing policy had been introduced in Saudi Arabia to combat inappropriate selfmedication with antibiotics . After the new policy had been implemented , there was a fall of about 10 % in the overall number of antibiotic doses issued . However , usage quickly increased to pre-policy levels and this was because doctors had started to prescribe antibiotics . He concluded that the supply of antimicrobial agents without a prescription should be prohibited and that measures to aid effective implementation of prescription-only regulations are necessary .
A project in Lebanon involved pharmacist-led education about AMR to junior and senior schoolchildren on the basis that this could stimulate AMR awareness at an early age and children could influence parents ’ behaviour . Evaluations before and after the intervention showed that there had been a significant increase in knowledge about AMR amongst participants , Dr . Dalal Hammoudi ( Lebanese International University ) told the audience .
Thailand has had a number of projects to promote appropriate use of antimicrobials . In 2016 , the country ’ s first National Strategic Plan in Antimicrobial Resistance 2017 – 2021 was published . By 2021 , reductions of 15.2 % and 24.8 % in the use of antimicrobial and antibacterial agents respectively in humans had been achieved , together with a 36 % reduction in the antimicrobial consumption in animals . There had , however , only been a 1.3 % increase in public knowledge of AMR and awareness of appropriate use of antimicrobial agents . The key challenges now were the complexities of AMR and fragmentation of data and databases , said Wirat Tongrod ( Pharmaceutical Association of Thailand ).
In the Western Pacific region antimicrobial guidelines are available but compliance tends to be poor , according to John Bell ( University of Technology Sydney and Chair , Australian Self Care Alliance ). In Malaysia and Fiji , antibiotics are prescription-only items but GP prescriptions are commonly dispensed without pharmacist oversight . In The Philippines “ no prescription , no dispensing ” is the rule but some antibiotics are still issued by dispensing doctors . The Australian Commission on Safety and Quality in Health Care ( ACSQHC ) recently issued its fourth report on antimicrobial use and resistance in human health and has also devised an Australian Priority Antimicrobials list and “ Antibiotic Prescribing in Primary Care : summary table ”.
According to Mr Bell ’ s analysis , some of the problems arise because antibiotics are relatively cheap compared with other treatments and consumer perspectives need to be shifted . Objective tests such as point of care testing for C-reactive protein could help to change attitudes , he suggested . The following general measures are also required :
• Structured and targeted educational programme on AMR from school onwards
• Separation of prescribing and dispensing
• Collaboration with other HCPs – especially primary care physicians
• Strong regulatory framework
• Greater presence of pharmacy in media – especially social media
Coronavirus and AMR A rapid living review of acute bacterial co-infections in COVID-19 included 28 studies and 3448 patients . The results showed that 3.5 % of patients had co-infections at the time of presentation , 15.5 % developed secondary infections after presentation and a total of 71.3 % received antibiotics . Overall , there was an 18 % reduction in community antibiotic consumption in the EU / EEA in 2020 and this was attributed to changes in health-seeking behaviour . In addition , surveillance and stewardship activities were deprioritised during the pandemic and AMR rose as a result .
Antibiotic prescription checklist During the discussion , Professor Philip Howard ( NHS England , North East and Yorkshire ) described how an antibiotic prescription checklist had been piloted in 66 community pharmacies . The checklist included several questions to ask the patient , and an assessment of whether the prescription followed current guidelines . More than 70 % of community pharmacists who took part in the pilot said that they would continue to use the checklist . The next stage of the project involves a roll out to 11,000 pharmacies for one year . Accompanying leaflets for patients have been developed and also digital versions of the documentation . Professor Howard said that he was keen to see the project rolled out globally next .
Suicide prevention The role of pharmacy teams in suicide prevention was first mentioned in the literature some 50 years ago and may be a commonly-overlooked resource , according to Dr Hayley Gorton ( Senior Lecturer in Pharmacy Practice , University of Huddersfield , UK ). Worldwide , more than 700,000 people die by suicide annually and the WHO has set a target to reduce suicides by one third by 2030 . In England and Wales , there were 10.7 suicides per 100,000 people in 2021 , the majority ( 75 %) were male and poisoning was the second most common method ( after hanging ), she continued . There are more than 11,600 community pharmacies in England and Wales and 89 % of people live with in a 20-minute walk of a pharmacy . In addition , pharmacy teams often know and recognise their patients and have consultation rooms where private discussion can take place . All these factors make community pharmacies particularly useful contact points for people who are contemplating suicide , said Dr Gorton .
Research conducted by her team 3 , 4 showed that about 11 % of pharmacists had prior training in suicide prevention and some 70 % thought that they had already interacted with at least one patient about suicide . In one case a patient had come to the pharmacy after a suicide attempt because he felt it was a safe place , she noted . Pharmacists have also had more dramatic experiences – one patient had telephoned for information about co-codamol tablets and it emerged that she had taken an overdose . After discussion , the pharmacist called for an ambulance . Another pharmacist reported witnessing a lady cutting her wrist and bleeding profusely . In this case , the pharmacist helped to stem the bleeding and called for an ambulance .
Often people who are thinking about suicide are referred to their GPs but the advantage of pharmacies is that they are open when GP surgeries are not , emphasised Dr Gorton . In this situation short-term prescriptions for antidepressants are sometimes issued . “ What a missed opportunity ! If only the doctor had told the pharmacist ….” then ongoing support could have been offered , she added .
Community pharmacy teams commonly identify training in suicide prevention as one of their key needs and Dr Gorton said that some 72,000 patient-facing community pharmacy staff had already completed the Zero Suicide Alliance training . In September 2022 , the National Institute for Health and
Care Excellence ( NICE ) had issued guidance 5 on self-harm
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