Nine in 10 community pharmacy teams in England engaged in antimicrobial stewardship (AMS) activities in 2021/22 using the TARGET Antibiotic Checklist, new data has shown.

And 54,399 registered pharmacy professionals – nearly all of the pharmacy professionals working in over 90% of community pharmacies in England – completed the AMS and Infection Prevention and Control e-learning programmes in 2020/21.

In addition, in 2021/22, 55,760 pharmacy dispensers, 29,659 pharmacists and 25,129 pharmacy assistants took the Antimicrobial stewardship for Community Pharmacy e-learning module, while 31,912 pharmacy dispensers, 14,008 pharmacists, 10,194 pharmacy assistants, 6,315 pharmacy technicians and 2,694 trainee pharmacists took the Infection Prevention and Control e-learning module.

NHS England said that this was a ‘solid foundation’ ahead of the upcoming Pharmacy First service, which will allow pharmacists to supply prescription-only medicines including antibiotics where appropriate for seven common conditions.

Pharmacy checks improve safety and appropriateness of antibiotics

Under the 2021/22 Pharmacy Quality Scheme (PQS), community pharmacy teams were required to use the TARGET Antibiotic Checklist with all patients presenting with an antibiotic prescription during a four-week reporting period, in order to meet the requirements for the PQS prevention domain.

Of the 89% of pharmacy teams that took part, 87% met or exceeded the target of 25 antibiotics checklists and just 14% submitted fewer than 25 checklists.

Altogether, community pharmacy teams submitted 213,105 checklists, with nearly all (99.5%) of these prescriptions being checked for safety and appropriateness, such as checking the dose, duration, appropriateness of the antibiotic and patient allergies and interactions.

In 1.3% of cases, pharmacy teams contacted the prescribing clinician to discuss the prescription. Of the 62% that gave a reason for this, over a quarter (26%) wanted to discuss the appropriateness of the antibiotic dose, 14% were concerned about a possible patient allergy, 9% wanted to discuss recent antibiotic use, 9% related to course duration and 6% were getting in touch about the choice of antibiotic.

And in over a third of cases where the outcome of a clinical discussion was reported (34%), the prescription dose, formulation, directions, strength, or duration was changed.

In 25% of cases, the prescriber confirmed the prescription was appropriate and did not need to change, and in 21% of cases, an alternative antibiotic was prescribed.

In 4% of cases the patient required a re-consult with the prescriber, and in 3% of cases the antibiotics prescription was cancelled.

Chest, urinary tract and tooth infections most common reasons for antibiotics

The most common reason for antibiotic usage was for a respiratory tract infection, at 29% of all antibiotic checklists.

Nearly half (47%) of submitted checklists confirmed that the patient had already received the influenza vaccination, with 26% of these eligible for the free NHS flu jab.

And as a result of using the antibiotic checklist with the patient, 16,625 additional influenza vaccinations were delivered by community pharmacy – 30% for patients eligible for free NHS influenza vaccinations and 70% for patients not eligible for a free NHS vaccination.

Following these findings, NHS England recommended that community pharmacy teams continue to promote influenza vaccination.

The second most common reason given for antibiotic use was for a urinary tract infection (UTI), representing one in five (20%) checklists submitted.

And 14% of all prescriptions that antibiotic checklists were submitted for were for tooth infections.

This comes as the British Dental Association (BDA) earlier this month announced a ‘crash’ in the number of practising dentists to 2012 levels, and called on the government to reform and properly fund dentistry in primary care.

A BDA spokesperson told The Pharmacist: ‘Pills – whether pain killers or antibiotics – will not solve problems that require an operative intervention. Failure to support access to dentistry is already piling pressure on overstretched healthcare colleagues across the NHS’.

Beat AMR by integrating community pharmacy into multidisciplinary teams

An NHS report on the findings said that the results ‘further highlight and recognise’ the ‘essential clinical role’ that community pharmacy staff play in AMS, as well as collaborative working with other primary care colleagues and continued public education to ensure the safe and appropriate use of antibiotics.

It said that community pharmacy teams had shown collaboration with general practice colleagues and ‘should continue to do this to optimise patient care’.

‘This may further reduce patient expectation to receive antibiotics for self-limiting infections and reduce pressure on prescribers in primary care to prescribe antibiotics’, the report continued.

‘These findings add to the evidence that community pharmacy can play a vital role in AMS and support the NHS in England to tackle the significant threat of AMR to public health’, it concluded.

It is recommended that Integrated Care Boards (ICBs) should work to integrate community pharmacy into multidisciplinary teams.

The NHS said that community pharmacy had a ‘solid foundation of knowledge and experience’ to build upon as the new Pharmacy First service, which will allow pharmacists to supply prescription-only medicines including antibiotics where appropriate for seven common conditions, is introduced from winter 2023.