‘Never been a worse time’ for pharmacy prescribing to expand

This year, the theme ‘Preventing Antimicrobial Resistance Together’ was chosen by the World Health Organization (WHO) to promote World Antimicrobial Resistance (AMR) Awareness Week, which runs from November 18–24.
 
The WHO has urged for interdisciplinary collaboration between leaders to combat the growing global health threat of AMR, which it considers to be one of the top 10 threats to global health, estimating that 10 million people will die every year as a direct consequence of AMR by 2050. 
 
Aside from resulting in death and disability, the WHO says AMR has significant impacts on the economy and results in prolonged illness and longer hospital stays that require more expensive medications.
 
The awareness campaign and call for joint action has coincided with the RACGP once again speaking out against the harms of pharmacy prescribing, after South Australia announced it will allow community pharmacists to treat presumed uncomplicated UTIs in women aged 18–65 by prescribing antibiotics from March 2024. Under the scheme, they will also be able to supply women with the oral contraceptive pill.
 
‘This pharmacy prescribing expansion may well seem like a convenient option; however, patient safety and wellbeing must come first,’ RACGP President Dr Nicole Higgins said.
 
RACGP South Australia Chair Dr Sian Goodson echoed these concerns and called for a greater focus on antimicrobial stewardship in the context of the WHO campaign.
 
‘There has never been a worse time to expand antibiotic prescribing,’ she said.
 
‘The fact that this week is World Antimicrobial Awareness Week highlights just why this decision is not in the best interests of patients.
 
‘WHO has declared that antibiotic resistance is a global health emergency [and] the Australian Commission on Safety and Quality in Health Care [ACSQHC] has urged judicious prescribing of antibiotics for a range of health conditions, including urinary tract infections.
 
‘We are heading in exactly the wrong direction, because introducing more non-medical prescribers of antibiotics through pharmacies risks undercutting our efforts to fight antimicrobial resistance.’
 
According to the latest state-of-the-nation report from the ACSQHC, Australia continues to rank highest in terms of rates of antibiotic prescriptions dispensed in the developed world; however, there are signs of improvement.
 
The Commission welcomed a reduction in overall antibiotic use when compared to previous years, which included fewer antibiotic prescriptions from GPs.
 
‘GPs and other health professionals in general practice know we need to be prudent in our use of antimicrobials, and this report reflects that,’ Dr Higgins said.
 
‘That’s what makes these pharmacy prescribing trials so alarming. Pharmacists don’t have the diagnostic skills of a GP nor the clinical setting to confirm a UTI. Sometimes antibiotics may not be required at all.’
 
Researchers from the University of Sydney recently published alarming findings in The Lancet Regional Health that showed antibiotics used for common childhood infections are no longer effective in the Asia pacific region due to AMR.
 
Lead researcher Dr Phoebe Williams says that AMR is more challenging in children as new antibiotics are less likely to be trialled on and made available to paediatric populations.
 
‘We are not immune to this problem – the burden of antimicrobial resistance is on our doorstep,’ she said.
 
‘Antibiotic resistance is rising more rapidly than we realise. We urgently need new solutions to stop invasive multidrug-resistant infections and the needless deaths of thousands of children each year.’
 
Earlier this year, RACGP WA Chair Dr Ramya Raman – who does not endorse pharmacy prescribing – worked alongside a team of medical experts, including infectious diseases physicians, to safeguard the community and reduce the risk of AMR as a result of pharmacy prescribing in her state. 
 
But despite the additional protections in place, she still remains wary of the potential dangers and has helped to arrange an upcoming event aimed at preventing antimicrobial resistance in primary care.
 
‘We have serious concerns about the WA pharmacist project and advocated successfully for the antibiotic cefalexin to be removed due to the heightened risk of antibiotic resistance its inclusion posed,’ she said.
 
‘While the retail pharmacy prescribing pilots do not align with RACGP’s position, the State Government took the risk of antimicrobial resistance seriously in its approach to this trial.’
 
Professor John Turnidge, Senior Medical Advisor for the Commission says therapeutic guidelines need to be followed and that every doctor and healthcare worker has a role to play in addressing the threat of AMR.
 
‘Let’s all think twice before automatically prescribing and using antibiotics – or having them “just in case”,’ he said.
 
‘If we don’t, in the future we may not be able to perform medical procedures such as organ transplants, cancer chemotherapy, diabetes management and major surgery.
 
‘That is a bleak future that none of us wish to contemplate.’
 
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