The pharmacy team can contribute to antimicrobial stewardship in primary care in a number of ways:

• Help to ensure that antibiotics are only prescribed when they are needed 

In community pharmacy, promoting symptomatic relief of infections and referring patients to the GP only when necessary is an important part of stewardship. The NICE clinical guideline 69, ‘Respiratory tract infections – antibiotic prescribing’, suggests that patients should be given advice on the natural history of an infection and the average illness duration (for example three weeks for acute cough). Pharmacy teams should be aware of the normal history of such conditions and be able to explain the lack of benefit of antibiotics in these cases. This will help to manage patient expectations and reduce referral to GPs. 

• Managing patient expectations 

Patient expectation plays a big role in the decision of a patient to consult their GP and also affects the doctor’s decision to prescribe. As described above, pharmacy teams have a role in discussing with patients whether they should be referred to a GP practice. Prescribers frequently assume a patient with an acute respiratory infection will not be satisfied unless they receive a prescription for an antimicrobial; whereas studies show that patients are often happier if they receive accurate explanations and reassurance, rather than inappropriate antimicrobial therapy. Once an antimicrobial has been prescribed for a patient, they are more likely to return for another antimicrobial prescription for the same condition in the future. 

There are a number of leaflets available for patients that can help explain the decision not to prescribe, such as the Antibiotic information leaflet and the When should I worry? booklet, both available from the Royal College of GPs’ TARGET Antibiotic Toolkit. 

Patient education is important and pharmacy teams should support national initiatives, such as European Antibiotic Awareness Day and World Antibiotic Awareness Week, and use materials made centrally available by the Department of Health for health promotion activities in their pharmacies to increase awareness of global antibiotic resistance.

Providing a delayed prescription is an approach that can be used by prescribers to reduce antimicrobial use. The patient is given a prescription and told to only have it dispensed if symptoms persist or get worse. Often they are given a set time frame for this. Pharmacy professionals can support patients in making a decision as to when the prescription may be needed and can advise patients of other self-management strategies that can be employed.

• Take steps to ensure people use their antibiotics properly 

Counselling patients when dispensing antibiotic prescriptions is key. Patients should be advised: 

• To take the antibiotic regularly, as directed 
• To finish the course even if they feel better or symptoms resolve 
• To discard unused antibiotics by returning them to the pharmacy (if they need to change medicines, following side effects or sensitivity reports) 
• Not to use out-of-date antibiotics 
• Not to take antibiotics prescribed for someone else.

Practice point 3

What is the TARGET antibiotics toolkit and how can it be of use in community pharmacy?