Community Pharmacy is one of the primary points of call for most patients in the healthcare system. It is meant to provide comprehensive and effective healthcare services to anyone who seeks it. Unfortunately, in recent times it is mostly seen as just a business venture with minimal regard for its healthcare provision status. The pharmacy has simply become a sales point for drugs, and a place for self-diagnosed individuals to acquire any drug they wish to self-medicate themselves. The ease with which Prescription-only-medication (POM) and controlled drugs can be acquired is alarming; to what purpose is a pharmacist then?
Antibiotics are a class of drugs that fall under POM, but this is not the reality in most pharmacies in the country. They are sold without prescription indiscriminately and dispensed without the supervision of a Pharmacist by any person in a pharmacy; some of whom are not adequately qualified to even work in the pharmacy. Irrational antibiotic sales/ dispensing coupled with lack of adequate medication counseling also leads to Antibiotic Resistance. Antimicrobial Resistance is a global issue which the World Health Organization (WHO) says, “threatens the effective prevention and treatment of an ever increasing range of infections caused by bacteria, parasites, viruses and fungi. An increasing number of governments around the world are devoting efforts to a problem so serious that it threatens the achievement of modern medicine. A post-antibiotic era – in which common infections and minor injuries can kill – far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century”.
This was acquired from a 2014 WHO report which further states, “the report makes a clear case that resistance to common bacteria has reached alarming levels in many parts of the world and that in some settings, few, if any, of the available treatments options remain effective for common infections.”These statements are far from being exaggerated, and in actuality may probably not fully capture the impending doom we most likely face.
Some causes of antibiotic resistance include;poor patient compliance, inappropriate use influenced by human desire for instant gratification, unaffordability, drug counterfeiting, and substandard drugs. Many people take antibiotics for silly reasons and in certain cases with no particular reasons. On one occasion a customer said to me, ‘I just feel like taking it’. This was disturbing to hear and quite funny, except I could not laugh for long since the statement directly reflects on the level of misuse and abuse of antibiotics in the country.
There has been a discovery void since the late 80’s on new antibiotic classes, and with the worsening problem of Antibiotic Resistance, steps should be taken to address this and help reduce the rate of resistance at the community level.As professionals, Pharmacists should endeavor in helping to slowing this global problem. We should try to change malpractices at every pharmacy we find ourselves whether as superintendents or locum pharmacists, our professional authority should be used in tackling this issue of antibiotic resistance. Active involvement in all transactions in the dispensary should be prioritized. The pharmacist and representing staff should always probe as to why a customer/patient needs an antibiotic without a prescription.
The time has come for the public to desist from this attitude due to unfounded reasons as to why they are taking these antibiotics, but this is unlikely to occur if Pharmacists are not the frontline in the dispensary/pharmacy. This issue should not be taken lightly by any professional, and as opinionated as this may be, should be taken sentimentally. The pharmacy is not meant to be a place where anyone can just walk in and start ordering for POMs, they most certainly need prescriptions!
Pharmacists who may find themselves in communities where these practices have taken root should beware of hard times and opposition to change the practice of indiscriminate and irrational antibiotic sale from both the staff and the public. Even though this may be the case, to yield should not be an option, instead professionalism should reign. It is disheartening to hear proprietors and sometimes pharmacists who leave the day to day running of pharmacies to Medical Counter Assistants(MCA), say and I quote “they are experienced MCAs and can handle it”. It could be utterly true that they are indeed experienced, but experience alone should not be the determining factor in delivering to our communities what they deserve, which is the highest standard of pharmacy practice. Professionalism and requisite knowledge such as in pharmacotherapy, pharmacology, medication management and review, drug interaction, proper antibiotic selection to state a few; which a pharmacist can deliver is not guaranteed to be delivered by an experienced MCA. The truth of the matter is that the above statement effectively means they are making really good turnovers, which is arguably what certain proprietors fully care about with almost no regard for health or antibiotic resistance.
We, as pharmacist should try to address this issue wherever we find ourselves and however possible. Gaining the trust of our staff and community is critically essential. Educating the staff and community on Antibiotic Resistance, probing customers or patients on their need for antibiotics and adequate medication counseling is essential. Education of staff shouldbe extensive; if possible in detailed and periodic presentations.
Addressing this problem which the community pharmacy has helped fostered will be a herculean task. As professionals, it is incumbent on us to properly select and rationally dispense antibiotics. We should clearly cut out from the bunch not by uttering our qualification but rather by our actions, explanations and demeanor when we interact with patients and deal with issues of antibiotics and other POMs. We should focus on gaining the trust and respect of each customer/patient by rational recommendation and dispensing alternative antibiotics or to antibiotics if available, and effective counseling to elicit compliance.Time is running out, and as ‘friends of the human’ race we are obliged to help in addressing this issue. We have been on the sidelines for far too long, it is time for us to be on the frontlines and be the ‘go-to-guys’ in the management of this public health issue.