Volume 8 Number 1 2024
Role of Pharmacists and Public Health in Antimicrobial Stewardship: Addressing Prescribing Patterns and Resistance in Elderly Populations and Patients with Decompensated Liver Cirrhosis
Abdullah Mohammed K. Al Shamari 1, Ali Ishq Mualla Almutairi1, Mohammed Ali Ibrahim Bakri1, Sami Saddah M. Alanazi1, Mohammed Merza Al Maani1, Saif Mohammed Abdulmohsen Alsahman1, Abdullah Saeed Abdullah Alshahrani1, Abdulrahman Abdullah M. Al Shahri1, Mutrik Mohammed S. Al Shuflut, Mazen Suwaylih O. Alhusayni1, Abdulaziz Mustoor Mujieb Alotaibi1
Journal of Angiotherapy 8 (8) 1-15 https://doi.org/10.25163/angiotherapy.8810356
Submitted: 02 June 2024 Revised: 26 August 2024 Published: 28 August 2024
Abstract
Background: Antimicrobial resistance (AMR) is a global health threat, which is particularly devastating in the elderly as a result of multisource chronic diseases, immune senescence, and intense exposure to antibiotics. Antimicrobial stewardship (AMS) is crucial to address inappropriate prescribing and resultant adverse events but it is restricted in older people's care. The purpose of this article was to consider the contributions to AMS and the tools for driving next steps toward the optimized use, and minimized resistance, and best patient outcomes given the role of the pharmacist and a public health framework, especially regarding our older adults. Methods: A narrative synthesis approach to review of published information and international guidelines was undertaken, with specific attention to how to prescribe in older patients, antibiotic related toxicities, stewardship strategies across typical infections, the role of the pharmacist, and wider public health in AMS. Results: Investigators assessed the difficulty of prescribing of aging adult by identifying comorbidities, poly-medications, and changed pharmacokinetics along with the most common adverse reactions, including gastrointestinal, neurologic, renal, hepatic, cardiovascular, and hematologic toxicities. AMS strategies, including biomarker inclusive initiation, compliance with guidelines, de-escalation, intravenous substitution and shorter duration were uniformly associated with favorable outcomes. Pharmacists are also central to the continuation of safe, evidence-based prescribing and medication education, pharmacotherapy management, and hospital drug reconciliation, andwork in concert with public health measures to support stewardship through surveillance, infection prevention, and public awareness efforts. Taken together these initiatives form a comprehensive approach for addressing the misuse and resistance to antibiotics. Conclusion: Integrating pharmacists’ clinical expertise with public health stewardship frameworks is paramount for combating AMR in elderly patients. Collaborative, patient-based AMS strategies focussing on elderly care are effective in decreasing bad events, preserving the effect of antibiotics and promoting individual and societal health.
Keywords: Antimicrobial Stewardship; Aged; Pharmacists; Public Health; Antimicrobial Resistance; Adverse Effects.
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