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Goff
be receiving an antibiotic. ASPs do not have sufficient
resources to review antibiotic therapy on that many patients.
The authors describe how to expand the reach of ASP by
incorporating all pharmacists in ASP.
I like to say ASP steers the ship but we need all hands on
deck to complete the journey. The authors cite our study
from The Ohio State University Wexner Medical Centers
ASP where we incorporated all pharmacists 24/7 to assist in
the management of patients with Staphylococcus aureus bacteremia.10 The ASP team was steering the ship (developed
the evidence based S aureus bundle) but all hands (every
pharmacist) were on deck. This approach not only amplified
ASP impact on patient care; it also improved clinical outcomes. I frequently hear comments that this approach only
works in large hospitals that have ID physicians and pharmacists leading ASP. I am quick to cite the success of ASP in
South Africa where there are only about 20 ID physicians in
the country and there are no ID trained pharmacists. Despite
these barriers, pharmacists initiated ASP with 5 low-hanging
fruit interventions in 47 hospitals across South Africa.11
Antibiotic use decreased 18%. The pharmacists had only 1
hour a day dedicated to ASP interventions. The success of
the pharmacist-led ASP in South Africa is a testimony to the
saying "where there is a will there is a way." All hospital
ASP's have barriers but every day spent discussing these barriers without actions is another day of antibiotic misuse in
patients.
I believe every pharmacist can make meaningful contributions to ASP. The following examples describe ASP roles
for pharmacists working in different positions within the
pharmacy.
** IV room: Pharmacists can always identify the most
"popular" IV antibiotic and recent trends or changes in
prescribing patterns. This information can help ASP
identify problems as they develop within the hospital.
** Order entry/verification of orders: Upon receiving an
order for 3 new antibiotics, the pharmacist can review
the medication profile for proton pump inhibitors
(PPIs) and call the physician to recommend discontinuing the PPI to decrease the risk of CDI. The ASP
should develop a script for the pharmacist and provide
literature references to support the intervention. The
pharmacist should document the ASP intervention.
** Clinical specialists: Non-ID trained specialists should
manage antibiotic therapy on their patients because
they make daily rounds on the patients and work with
the medical team as decisions are made. ASP should
provide education to the specialists to empower them to
make antibiotic approvals for restricted or "protected"
antibiotics. Specialty pharmacists should request ASP
assistance for difficult cases or infections caused by
MDROs.
** All pharmacists: Education is a key component of ASP.
You do not need to be ID trained to provide education
about the responsible use of antibiotics. Every November

the WHO and the Centers for Disease Control promote
Antibiotic Awareness Week. During this week, pharmacists can volunteer to talk to elementary, middle school,
or high school students about antibiotics. I like to use
glow gel to demonstrate how many germs are on their
hands. This link provides access to several free educational resources from the CDC:
|| https://www.cdc.gov/antibiotic-use/week/educationalresources/resources.html
View a TedX talk on YouTube titled Antibiotics "justincase", where I describe how consumers, patients,
and HCP can all become stewards of antibiotics:
||

https://www.youtube.com/watch?v=ALryAB_
AYiA

Soon the requirements for ASP will expand from the hospital
setting to the outpatient setting. This presents an amazing ASP
opportunity for pharmacists in every type of setting, not just the
hospital setting. Collaborative practice agreements are providing new opportunities for pharmacists to practice at the "top of
their license" and to support appropriate use of antibiotics.
Antibiotic resistance impacts everyone. At some point, it may
be you, your parents, spouse, child, or friend who will acquire
an infection due to a MDRO. Antibiotic stewardship is for our
children's children. Pharmacists can step up and embrace the
call to action for antibiotic stewardship. If not us, then who?
References
1. UN health agency finds high levels of antibiotic resistance
to world's most common infections. https://news.un.org/en/
story/2018/01/1001461. Published January 28, 2018. Accessed
March 18, 2018.
2. Kanafani ZA, Zahreddine N, Tayyar R, et al. Multi-drug resistant Acinetobacter species: a seven-year experience from a tertiary care center in Lebanon. Antimicrob Resist Infect Control.
2018;7:9. doi:10.1186/s13756-017.
3. McNulty CAM, Lecky DM, Xu-McCrae L, et al. CTX-M
ESBL-producing Enterobacteriaceae: estimated prevalence in
adults in England in 2014 [published online ahead of print March
5, 2018]. J Antimicrob Chemother. doi:10.1093/jac/dky007.
4. Cohen B, Liu J, Cohen AR, Larson E. Association between
healthcare-associated infection and exposure to hospital roommates and previous bed occupants with the same organism
[published online ahead of print February 28, 2018]. Infect
Control Hosp Epidemiol. 2018. doi:10.1017/ice.2018.22.
5. Gandra S, Trett A, Klein E, Laxminarayan R. Is antimicrobial
resistance a bigger problem in tertiary care hospitals than in
small community hospitals in the United States? Clin Infect
Dis. 2017;65(5):860-863.
6. Fleming-Dutra K. Why do we prescribe antibiotics when they
aren't needed? Date unknown. https://blogs.cdc.gov/safehealthcare/why-do-we-prescribe-antibiotics-when-they-arentneeded/. Accessed March 20, 2018.
7. Spellberg B, Guidos R, Gilbert D, et al. The epidemic of
antibiotic-resistant infections: a call to action for the medical
community from the Infectious Diseases Society of America.
Clin Infect Dis. 2008;46(2):155-164.

https://www.cdc.gov/antibiotic-use/week/educational-resources/resources.html https://www.cdc.gov/antibiotic-use/week/educational-resources/resources.html https://www.youtube.com/watch?v=ALryAB_AYiA https://www.youtube.com/watch?v=ALryAB_AYiA https://news.un.org/en/story/2018/01/1001461 https://news.un.org/en/story/2018/01/1001461 https://blogs.cdc.gov/safehealthcare/why-do-we-prescribe-antibiotics-when-they-arent-needed/ https://blogs.cdc.gov/safehealthcare/why-do-we-prescribe-antibiotics-when-they-arent-needed/ https://blogs.cdc.gov/safehealthcare/why-do-we-prescribe-antibiotics-when-they-arent-needed/

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