Infections caused by bacteria can be treated with antibiotics. However, the World Health Organization (WHO) warns of a global threat called antimicrobial resistance (AMR). (1) Bacteria, viruses, fungi, and parasites (microbes) that did not respond to antibiotics are now more difficult to treat, increasing the risk of spreading disease, serious illness, and even death. To highlight the important role of pharmacists in addressing this threat, the Philippine Society of Hospital Pharmacists, in collaboration with Sandoz, through its Medix platform, organized the 1st.S t Pharmacists Antimicrobial Stewardship Summit on December 5, 2021. The goal of antimicrobial administration is to increase the effectiveness of antimicrobial drugs (including antibiotics), improve patient outcomes, and reduce the level of microbial resistance.
In 2015, the WHO declared antimicrobial resistance to be a global threat and a threat to development and is one of the top 10 global public health threats facing humanity. It requires urgent multisectoral action to achieve the Sustainable Development Goals (SDGs).
By 2050, up to 10 million people could die each year from AMR if immediate and effective action is not taken, according to The Pharmaceutical Industry and Global Health: Facts and Figures 2021. (two)
During her opening remarks, Ms. Christina Liza Sta. Maria, President of the Philippine Society of Hospital Pharmacists, said, “We as pharmacists are an integral part of this stewardship program. We play a vital role in preserving the weaponry used in antimicrobial therapy and, consequently, in improving patient outcomes. We support the defense of the AMR. In our quest for better health systems, this summit can strengthen our determination to become the forefront of appropriate antimicrobial use. “
For his part, Mr. Anthony Aldrin Santiago, Officer in Charge of the Board of Pharmacy of the People’s Republic of China, applauded the initiative to hold the first AMS summit and encouraged pharmacists to be proactive in the fight against AMR. “Nagsisimula ang lahat sa consciousness. But Hindi lang dapat may alam; dapat may pakialam. The AMR problem may be a natural solution to antimicrobial administration. Taking out the pharmacists mga, magician butler of the medication. ” (It all starts with awareness. But it doesn’t end there. We need to be aware. We need to take action. There is great hope of addressing the AMR problem, and we know the solution: antimicrobial administration. To all of our pharmacists, become the steward. of medications).
Initiatives to support AMS
According to Dr. Regina Berba, chair of the DOH’s AMS Steering Committee, AMS is committed to always using antibiotics properly and safely, choosing the correct antibiotics, and administering them in the correct way in each case.
WHO and DOH have launched initiatives to support the fight against AMR. Ms. Carmela Barcelona, Technical Assistant of WHO Philippines shared three initiatives led by WHO.
The 2019 WHO AWaRe classification database was developed on the recommendation of the WHO Expert Committee on the Selection and Use of Essential Medicines. It includes details of 180 antibiotics classified as Access, Watch or Reserve, their pharmacological classes, Anatomical Therapeutic Chemical (ATC) codes and the status of the WHO Essential Medicines List. It is intended to be used as an interactive tool for countries to better support the monitoring and optimal use of antibiotics.
WHO launched the Global Antimicrobial Use and Resistance Surveillance System (GLASS), the first global collaborative effort to standardize AMR surveillance. GLASS was created to support the second objective of the Global Action Plan-AMR initiative to “strengthen knowledge through surveillance and investigation”, and continue to fill the knowledge gaps, with the objective of informing strategies in all levels.
In 2020, Ms Barcelona led the pilot test for the rapid evaluation of AMS programs for level 1 to 3 hospitals in the country. The study identified strengths and gaps in AMS programs that were implemented in Philippine hospitals between 2015 and 2019.
“Addressing AMR is a shared responsibility. Everyone has a role to play. We pharmacists have a very important role in the fight against antimicrobial resistance and especially through antimicrobial administration. I command you all to be stewards of the future. Please stop the misuse and overuse of antibiotics. Join the AMR movement, ”said Ms. Barcelona.
Following the launch of the WHO Global Action Plan on Antimicrobial Resistance, DOH broadcast the program locally. Dr. Berba shared the programs launched by DOH: the National Antibiotic Guidelines, the Philippines Action Plan to Combat Antimicrobial Resistance, the Manual of AMS Procedures in Hospitals and the Manual of AMS Procedures in Primary Care of Health.
With the threat of the global COVID-19 pandemic, Dr. Berba also noted that DOH’s AMS steering committee calibrated the AMS program to adapt to new challenges and maximize opportunities to engage and mobilize pharmacists and partners in AMS across the country.
“AMR is an urgent and serious global problem. AMS is the only health solution. We must all be part of the fight against antimicrobial resistance. Together, we have to do it and we will do it. Together, we have to do it and we will do it even with COVID 19, ”said Dr. Berba.
AMS on the ground
As stewards of antimicrobials, pharmacists play a critical role in surveillance, optimization of drug therapy, monitoring and adherence to common pathways guidance, and educational training through public participation. To achieve their AMS roles on the ground, they use two intervention strategies: restrictive and persuasive. Through these strategies, they aim to safeguard and guarantee the optimal use of antimicrobials and optimize the clinical results of patients.
Ms. Sheryll Ann Limson, Executive Vice President of the Philippine Society of Hospital Pharmacists, commented that restrictive strategies aim to control antimicrobial use by instituting “barriers” to prescribing certain antimicrobials, administering certain antimicrobials, or after a period of time . Under restrictive strategies, pharmacists implement formulary restriction and prior authorization and 7the Automatic daytime shutdown for antimicrobial use.
“We need to participate in our AMS program in our hospitals, especially if we are hospital pharmacists. If not, we can still participate in AMS programs and do our part in AMR prevention, ”Ms Limson encouraged her fellow pharmacists.
For her part, Lic. María Katrina Rayos, Pharmacist at The Medical City AMS, highlighted that
Persuasive strategies aim to persuade healthcare professionals to prescribe appropriately by addressing underlying knowledge gaps, attitudes, and / or behavior through active interaction and discussion. Under persuasive strategies, pharmacists use audit and feedback, and intervention at the point of care.
Take small steps. Constant communication is important to help our patients understand us and we understand them, ”remarked Ms. Rayos.
There is no one way to solve AMR. In her closing message, Dr. Mary Ann Evangelista, Sandoz Philippines Director of Medical Affairs, Patient Access and Public Affairs, highlighted: “As the world’s leading provider of generic antibiotics, Sandoz Philippines is committed to improving global access to generic antibiotics. medicines and we are equally committed to ensuring the responsible use of medicines. Managing AMR and maintaining AMS is a collaborative effort between all of us, healthcare workers, patients, and the community at large. We are all involved in this global threat. There is no quick fix for this. All our efforts count. “
The Antimicrobial Stewardship Program (AMS) is a concerted effort to improve the appropriate use of antimicrobials in public and private hospitals in the Philippines, across a wide range of disciplines.
Visit the Interagency Committee on Antimicrobial Resistance (https://icamr.doh.gov.ph/) for more information on the AMS program in the Philippines.