Posted by: ayrshirehealth | August 19, 2015

Antimicrobial pharmacist – what’s that about? by Nik Reid & @dtbarron

Interview with an antimicrobial Pharmacist

DTB: First, tell me a bit about what it is you do.

NR: I am a pharmacist and microbiologist by training and I lead a small team of pharmacists, microbiologists and a data analyst, working in hospital and community.antimicrobial pharmacist

Together, we work to ensure that patients receive the most effective treatment for their infection while minimising side effects and the development of resistance.

Much of my work is spent writing the antimicrobial formulary, educating prescribers, and auditing antimicrobial use, feeding the results back to the prescribers.

DTB: I see that NHS Ayrshire & Arran have launched a new antimicrobial app – what was the thinking behind that?MicroGuide desktop

NR: There is a wealth of evidence to suggest that smart phone apps are particularly successful at providing easy access to drug formularies. Most clinicians now have a smart phone and the app is easily accessible and always up to date.

Formulary apps improve formulary compliMicroGuideance which in turn reduces the risk of acquiring an Healthcare Associated Infection such as C diff., developing resistance or inducing an adverse drug reaction.

DB: How will the app help clinicians in making choices when it comes to prescribing antibiotics?

NR: The app uses a system based decision tree allowing rapid selection of the appropriate condition, as well as treatment options including appropriate dose, frequency and duration.

DB: Why is that important?

MicroGuide 2NR: It is important to make sure patients receive the most appropriate antibiotic for their infection. Most infections are diagnosed without knowing which specific bacterium is causing the infection, so the formulary is written to cover all the common likely pathogens.

In addition, we try to minimise the risk of the organism being resistant to the antibiotic, to keep side effects to a minimum and finally to make sure the treatment is cost effective, allowing us to treat as many patients as possible.

DB: We know, because of national campaigns, that antibiotics don’t work for a virus, but they do for an infection – why is it important to use the right one?

NR: Antibiotics don’t work against viruses so it is important to only use antibiotics to treat bacterial infections.  If an antibiotic is given for a viral infection or the wrong antibiotic is given for a bacterial infection, first and most importantly of all, it won’t work.

In addition, the patient may have side effects, and the antibiotic may induce resistance in other bacteria the patient is carrying. Once a bacterium becomes resistant to an antibiotic, it can spread that resistance to other, more pathogenic bacteria, and those bacteria can then spread into the environment and from person to person.

DB: How do we know which is likely to be the right antibiotic?

MicrobiologistAll samples collected from patients are analysed in the local microbiology laboratory, and this gives us a wealth of information telling us the most likely pathogens for each infection and the antibiotics they are sensitive and resistant to.
This allows us to predict the most effective antibiotic for each common infection, and this information is used to write the formulary programmed into the MicroGuide app.

DB: Is the app, and it’s info, only relevant within a hospital setting?

NR: The microbiology data we collect covers all patients in hospital and the community, and the formulary is also written to provide the best treatment to patients in all care settings.  MicroGuide is particularly useful for GPs visiting patients in their own homes, as it provides prescribing advice in their pocket.

DB:  What are the issues we are facing, at a Scotland-wide level with antibiotics?

NR:  All the problems we face locally are also seen nationally and internationally, including antimicrobial resistance, C diff and other healthcare associated infections.  GentamicinWithin Scotland, when the formularies were changed to try and reduce C diff, the fear was that this would lead to unintended consequences such as increased resistance to the new antibiotics, especially gentamicin, as well as side effects such as kidney damage and damage to the middle ear leading to tinnitus and loss of balance.

These unintended consequences have been closely monitored and have not so far proved to be a problem, but any change to a formulary brings unintended consequences, so it is important to monitor these changes closely.

DB: Is this the same across the UK and beyond?

NR: Resistance is a problem worldwide and these organisms easily cross geographical boundaries. Organisations such as the World Health Organisation and the Centre of Diseases Control in the USA monitor international levels of resistance and produce regular reports. Antimicrobial resistance was recently raised as an international concern and was described by the World Health Organisation as one of the three greatest threats to humankind in the 21st century. Both these organisations now talk of the dawn of a post-antibiotic era, as we return to an era where antibiotics no longer work. For some infections, this is already the case.

DB: Are there any key messages you would like to share about the app or about antibiotics more generally?

NR: I would like to encourage prescribers to download the MicroGuide app, as it provides the most up to date prescribing information and allows my team to update the formulary quickly in response to changes in local resistance. AntibioticsI would also encourage prescribers to think if their patient needs antibiotics and encourage patients to not always ask for antibiotics.

There are situations where antibiotics are just not needed, such as a common cold, and if we avoid using antibiotics for these simple infections then we may be able to keep them working longer.

The pharmaceutical companies are researching new antibiotics, and any additional time we can give them to bring a drug to market will ensure we don’t run out of effective antibiotics.

For further information, please see www.antibiotic-action.com

This week’s blogger Dr Nicholas Reid, was interviewed by @dtbarron (Derek Barron).  Dr Nicholas Reid  is Principal Pharmacist, Antimicrobial Pharmacotherapy, Pharmacy and Medicines Utilisation, NHS Ayrshire and Arran.

 

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Responses

  1. Timely blog on anti microbial prescribing. With such a high public health risk it’s good to see responsive solutions to help clinicians to keep patients safe

  2. Hi! I think I found your bag on the train to Kilmarnock it’s an orange rucksack!

  3. I think I found your orange rucksack on a train tonight? I did some digging and I think I’m right that it’s yours?


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