THE ROLE OF PHARMACY:

EXPERIENCE FROM LATAM

Carlos Lacava, Vice-president of the International Pharmaceutical Federation (FIP), spoke about the role of the pharmacist in addressing AMR

The International Pharmaceutical Federation (FIP) is the global body representing pharmacists and pharmaceutical scientists all over the world. There are over 150 national organizations, academic institutional members and individual members from more than 100 countries. FIP represents 4 million pharmacists and pharmaceutical scientists around the world. There is a strong relationship between FIP and GRIP. For the last 2 years GRIP members have been invited to speak at the annual FIP World Congress of Pharmacy and Pharmaceutical Sciences. Both events were extremely well attended and underlined the need for a specific AMR forum at FIP which is due to launch later this year.

In terms of the role of pharmacy in the control of AMR, FIP published a reference paper on fighting antimicrobial resistance in 2015. It sets out that, “Pharmacists have a unique position in health care systems that makes them the most accessible health care professional. Through a process of triage, pharmacists evaluate whether or not they can offer a solution via the treatment of minor ailment symptoms. Furthermore, when antibiotics are not needed, pharmacists can reassure patients and correct any misunderstandings”. (Access more information here https://www.fip.org/file/163)

In 2017, FIP approved a policy statement for the role of pharmacy in the control of AMR (more information here https://www.fip.org/file/1598 ). It sets out a number of recommendations for pharmacists, Governments and a commitment from FIP. Mr Lacava explained that whilst these documents are tools for guidance on AMR, they are not the only actions from FIP as AMR remains a key issue that features in both FIP webinars and congresses.

Mr Lacava then spoke more specifically about the situation in Latin America. He said, “There are different ways pharmacists work. Some countries, like Argentina for instance, have the presence of a pharmacist the whole time in the pharmacy. For others, like Uruguay and Mexico, by law they have to have a pharmacist, but in practice the pharmacist is not there. They are responsible for what happens but they are not there all the time”.

For this reason, the Pharmaceutical Forum of the Americas (PFA) is taking an important role in promoting the basic tools for fighting AMR and has the support of FIP and the Pan American Health

Organisation (PAHO). Since 2016, the PFA has offered grants for projects, with AMR being one of the themes proposed. During World Antibiotic Awareness Week last year, they hosted a webinar on “Antimicrobial optimization programs and the essential role of the pharmacist”. FIP was used as a platform and the activity was offered for free to all pharmacists.

A closer look at Uruguay

Mr Lacava shared some specific examples of how the pharmacist has played an influencer role in Uruguay. For context, whilst in Uruguay the law states that antibiotics must be dispensed only with medical prescription, this is not always the case in practice.

Mr Lacava explained that “campaigns continue to promote the responsible use of antibiotics: not to use antibiotics for usually viral diseases (like upper respiratory tract infections), use antibiotics only with a prescription, do complete the full treatment course and don’t use leftovers from a previous treatment”. The final point was emphasised because in Uruguay, the full box is dispensed rather than just the precise number of doses needed. This results in leftover medication that is often reserved for the next use or given to family members.

A case from Costa Rica

The next case presented by Mr Lacava was from the first public hospital to implement an ‘Antimicrobial Stewardship Programme’ started in 2018. The study was first done in orthopaedics and due to its success, this will be extended to the haematology department this year.

Results so far have been impressive with a reduction of almost $40,000 in the antimicrobial consumption expenditure compared to the previous year, through a reduction of the defined daily dose amongst other measures. The development of treatment guidelines for pre-surgical prophylaxis and a guide for treatment of surgical site infection also resulted. Mr Lacava concluded, “They are happy and proud to be able to demonstrate to the hospital authorities that stewardship in antimicrobial programmes is very useful”.

The case demonstrates the tremendous impact that individual pharmacists can make when they take on an antimicrobial stewardship role within their hospitals.