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About one third of hospital patients are prescribed antibiotics and up to 50% of their use is unnecessary or inappropriate. ECDC data clearly reveals the causal association between the indiscriminate use of antibiotics and the spread of drug-resistant infections, also known as antimicrobial resistance (AMR). Whilst some EU countries have made significant strides in control of drug-resistant infections, overuse and the spread of AMR urgently need to be addressed in others. As drug-resistant infections are not contained by national borders, the approach must be strict, consistent and coordinated at European and international level.

By Sascha Marschang, Policy Manager for Health Systems, EPHA.

Why Antimicrobial Stewardship?

Antimicrobial stewardship (AMS) was a hotly debated topic at the 21st Congress of the European Association of Hospital Pharmacists (EAHP) in Vienna. Great emphasis was placed on the necessity to establish well-trained, multidisciplinary teams supported by committed leadership in order for AMS programmes to be fruitful. As medicines experts with knowledge of infection control, hospital pharmacists play an important role as educators of other healthcare workers and patients.

Antimicrobial stewardship (AMS) can be described as a series of multi-professional interventions across all care settings. Alongside infection control and decontamination action it has become an essential strategy deployed in hospitals across Europe to fight multi-drug resistant ‘superbugs’.

Efficient AMS programmes hinge on first-rate management skills across hospital and community settings, and the availability of local guidance. This must go hand in hand with surveillance data on antibiotics use and occurrence of resistance so that compliance with guidance can be measured, and its impact evaluated.

Contribution of Hospital Pharmacists

Subtitled ‘Hospital pharmacists taking the lead – partnerships and technologies’, the EAHP Congress discussed the importance of providing patients with appropriate treatments and demonstrated how hospital pharmacists contribute to fighting AMR by using their expertise (including clinical skills, communication, data analytics, and audit) as members of multi-professional AMS teams. In particular, their role in educating other hospital staff, patients and students, and as compliance agents who check that policies are adhered to, is vital for improving patient outcomes. In a workshop on antimicrobial optimisation, Dr Jacqueline Sneddon (Scottish Antimicrobial Prescribing Group) underlined that determining the appropriate initial antibiotic treatment while avoiding unnecessary use is a balancing act. A growing number of on- and offline support tools are available for meeting the antimicrobial challenge.

As affirmed by EAHP President Joan Peppard, hospital pharmacists represent an essential link between medication development and patient outcomes. She stated they are ready to embrace innovation and advanced practice, guided by the European Statements of Hospital Pharmacy endorsed in 2014.

Patient empowerment and research needs

The benefits of forging close partnerships with patients and families was highlighted by Vincent Dumez and Marie-Claude Vanier (University of Montreal) who emphasised that patients are ‘living with an illness’ experts while healthcare professionals are disease experts. By empowering patients throughout the care process, informed patients represent a crucial resource, including for tackling health threats.

Finally, the potential value of older antimicrobials and the challenge of developing new ones under the reigning business model were discussed. Although older products may prove valuable in treating multi-drug resistant strains, they have not been developed to modern standards and there is a lack of data on their effectiveness and quality. More research and funding, including also into alternatives to antibiotics is required to tackle AMR.

EPHA believes that Europe can play a bigger coordination role in this regard, e.g. by providing coherent guidance for the use of antibiotics in human health, promoting AMS across the Union, closing research gaps, and setting binding reduction targets.

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