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Workshop on Antibiotic Stewardship,
Principle and Practice by PSHSP

KARACHI: As Young pharmacist there can never be prouder moment when a young Pharmacist working on different capacity take up a leadership role. If I say my one single achievement I would say that it was the training programme at AKU Hospital which has developed, created the kind of pharmacists who are running the State of the art center all over the country and I don’t see a single place in Pakistan which does not have representation of that programme. These views were expressed by Mr. Latif Sheikh, President & CEO Pakistan Society of Health –System Pharmacists (PSHSP) while speaking at a workshop on Antibiotic Stewardship, Principle and Practice organized by PSHSP at Karachi on 7th March, 2020. It was very well attended by Pharmacists working at different hospitals, pharmacies, and Pharma industry.

Continuing Mr. Latif Sheikh that it was a Proud moment when I was auditing SKMT on behalf of American Society of Health System Pharmacists to accredit their pharmacy training and hearing the comment of the auditors of ASHSP would say was music to my ears that’s how good work Pharmacist in Pakistan are doing. When I joined this society, our main objective was to build capacity amongst our pharmacy Students. We did not want health system to be confined to hospital pharmacy only, we were looking as a system getting all sorts of modules, components and the literary care to be the very much part of health system. Pharmacovigilance which is now a new language of pharmacy and sub specialties of pharmacy have been developed over the last several years. How important antibiotics are, unfortunately we have a corona virus which has created panic on our faces but at the end of the day it is the antibiotics because it has been a challenge now for many years, what is happening in Pakistan and globally.

Antimicrobial resistance Mr. Latif Sheikh stated has been recognized as a global emergency medicine, it has been declared global emergency by WHO and Different Disease Control and Prevention Group of D-20 countries. It has declared resistance emergency. UN General Assembly has in its resolution suggested to look at the misuse of antibiotics and antimicrobials and it should be looked at a level of emergency. About 24% of total expenditure of our country spends on systemic antibiotics that also tells you that why it is so important that pharmacists are component part and parcel of wherever these therapeutic modalities are being used. In European Union around 48,000 people die every year because of antibiotic resistance, infection by resistance, bacteria most difficult to treat and more likely to complicate many aspects of hospitalization and the kind of economic impact. It cost 21 to 34 billion US$ to US healthcare system because of antibiotic resistance, more than eight billion extra days in hospitals. One of the major way they are trying to improve their healthcare system is to curtail antibiotics resistance. Antimicrobial Stewardship program is a coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy and route of administration cannot be run until and unless you have a team which includes Physician, Pharmacist, microbiologist, epidemiologist, Nurses and IT Person and person from infectious control.

Mr. Kashif Hussain, Manager Pharmacy Services AKU, Karachi was the facilitator at the workshop. The main objective of this workshop was an effort to contribute and equip our Pharmacists to structure, develop and implement ASP in their work-setting to foster appropriate use of antimicrobials ultimately in successful therapeutic outcome for patients and reduce the risk of infections for other patients and health care workers. The world today is going through a calamity of antibiotic resistance which has become a major threat to health & human development. Irrational use of antibiotics and limited enforcement on usage has put our generation and the ones to come in danger. A system & successful Antibiotic Stewardship Program needs to be in place which cannot be achieved without success stems generating from a joint collaborative effort between pharmacy, medicine, and infection control (IC), microbiology, and information technology.

Addressing the participants Mr. Kashif Hussain said that we should know the diagnosis criteria, until we are not aware of it, it is useless. We need to be clinically strong, if we know then we can help the physician otherwise it is of no use. We have to educate ourselves, have to learn from wards and have to document it further study it. It is time to do stewardship of PPI’s but we are still doing stewardship of antibiotics in Pakistan. All drugs have adverse effects, antibiotics have an additional effects known as collateral damage. Antibiotics resistance bacteria cause twenty three thousand deaths and two million illness yearly. Twenty five thousand people die each year in Europe from antimicrobial resistance and more than seven hundred thousand deaths are reported in Asia, Africa due to antibiotic resistance. Antibiotic development is dwindling, new antibiotics are not coming in our country, all are launched in other countries which we have not introduced yet.

The role of the antibiotic stewardship programme He stated is to strike balance between appropriately treating the patient and avoiding the selection of antibiotic resistant organisms. Antimicrobial stewardship is an activity that promotes the appropriate selection of antimicrobials, dosing of antimicrobials, route and duration of antimicrobials therapy, ultimately control the emergence of resistance and reduce the treatment related cost. Composition of ASP team is led by Physician and Pharmacists, microbiologist and other can be included like epidemiologist, Nurse and IT Person and person from infectious control. Minimum ASP includes physician and pharmacist. Antimicrobial stewardship team core strategies includes prospective audit with intervention and feedback that can result in reduced inappropriate antimicrobial use which will be ongoing activity. Formulary restrictions and pre authorization can lead to significant and immediate reduction in antimicrobial use and cost. There are 5D’s for stewardship which includes, diagnosis, drug, dose, duration and de-escalation.

At AKU ASP was started with antibiotic sub-committee of P & T committee formulated in 2001. The committee was renamed as Antimicrobial Stewardship Committee in 2017 with the aim to rationalize the use of antimicrobials, strategize to reduce the resistance, advisory and education role, system implementation and process defining. Leadership commitment for the success of ASP is very important, he added. Overuse /abuse of antimicrobials affect everyone, we can help by requesting prescriber to document antimicrobial indication on chart, antimicrobials warranted, encourage the prescriber to request to ID approval for restricted antimicrobial, ask questions about antimicrobial duration and encourage IV to oral switch. Ms. Maheen Muzammil, Clinical Pharmacist at AKU discussed ASP in OPD settings and discussed case studies.

Mr. Haroon Qasim, Managing Director PharmEvo speaking in the concluding session said that Industry is responsible to take in control in which area they can promote their products and follow ethical practices. We have to be very careful in marketing and convince the doctor and pharmacists. Major responsibility lies on the Pharma industry to control unnecessary use of antibiotics, it should be discouraged and we have to be very careful in promoting our products.

Dr. Kaiser Waheed, Chief Executive Medisure in his remarks said that empirical use of antibiotics should be stopped. Competent pharmacists should be appointed in pharmacies. Typhoid resistance is becoming alarming, we have to be selective in use of antibiotics, he added.

Mr. Zahid Saeed Chief Executive Indus Pharma said that Pharmacist, and Pharma companies need to work together to stop misuse of antibiotics, we have to follow SOP’s. We lack local research and need to find solutions to tackle this problem. Until and unless we have a proper healthcare for our people unnecessary use of injections therapy will not stop. Until Sustained Development Goals are not achieved we will not be able to improve healthcare, we have to see the ground realities, he added.

Mr. Latif Sheikh in his concluding remarks said that Pharmacist has commitment to provide bridge with Pharma industry. I would anticipate that pharmacists and industry can work together in different research projects. We should help our Pharma industry by working together which will provide patients safety and avoid ugly incidents and happenings like we witnessed in our healthcare facilities recently. Pharmacists have a responsibility to take prominent roles in ASP and participate in the infection prevention and control programs of health systems. It should be a regular activity for further enhancement of pharmacy services in our country, he concluded.

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