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 failed to respond to antibiotics are now harder to treat, increasing the risk of disease spreading, serious illness, and even death.  To highlight the important role of pharmacists in addressing this threat, the Philippine Society of Hospital Pharmacists in partnership with Sandoz, through its Medix platform, organized the 1st Pharmacists’ Antimicrobial Stewardship Summit last December 5, 2021. The goal of antimicrobial stewardship is to increase the effectiveness of antimicrobial drugs (including antibiotics), improve patient outcomes, and lower the level of microbial resistance.  

In 2015, the WHO declared that antimicrobial resistance is a global threat and development threat and is one of the top 10 global public health threats facing humanity. It requires urgent multisectoral action in order to achieve the Sustainable Development Goals (SDGs).

By the year 2050, up to 10 million people could die annually from AMR if no immediate and effective action is taken, according to The Pharmaceutical Industry and Global Health: Facts and Figures 2021. (2)

During her opening remarks, Ms. Christina Liza Sta. Maria, Philippine Society of Hospital Pharmacists President said, “We as pharmacists are an integral part of this stewardship program. We have a vital role in preserving armament used in antimicrobial therapy and consequently improving patient outcomes. We support AMR advocacy. In our pursuit of better health systems, may this summit strengthen our resolve to become vanguards of proper antimicrobial use.”

For his part, Mr.  Anthony Aldrin Santiago, PRC Board of Pharmacy Officer-in-Charge, applauded the initiative to hold the first AMS summit and encouraged pharmacists to be proactive in the fight against AMR. “Nagsisimula ang lahat sa awareness. Pero hindi lang dapat may alam; dapat may pakialam. May malaking pag-asa sa problema ng AMR dahil alam natin ang solusyon dito – ang antimicrobial stewardship. Sa ating mga pharmacists, maging steward of medication.” (Everything starts with awareness. But it does not end there. We need to be aware. We need to take action. There is great hope to address the AMR problem and we know the solution – antimicrobial stewardship. To all our pharmacists, become the steward of medication.)

Initiatives to support AMS

According to Dr. Regina Berba, DOH AMS Steering Committee Chairperson, AMS is the commitment to always use antibiotics appropriately and safely, choose the right antibiotics, and administer them in the right way in every case. 

WHO and DOH have launched initiatives to support the fight against AMR. Ms. Carmela Barcelona, WHO Philippines Technical Assistant shared three initiatives led by WHO. 

The 2019 WHO AWaRe Classification Database was developed on the recommendation of the WHO Expert Committee on 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 WHO Essential Medicines List status. It is intended to be used as an interactive tool for countries to better support antibiotic monitoring and optimal use.

WHO launched the Global Antimicrobial Resistance and Use 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 research”, and to continue filling knowledge gaps, with the aim to inform strategies at all levels.

In 2020, Ms. Barcelona led the pilot rapid assessment test of AMS programs for levels 1 to 3 hospitals in the country. The study identified strengths and gaps in AMS programs being implemented in Philippine hospitals from 2015 – 2019.

“Tackling AMR is a shared responsibility. Everyone has a role to play. We, pharmacists, have a very important role in combating AMR and especially through antimicrobial stewardship. I enjoin everyone to be a steward for the future. Please stop the misuse and overuse of antibiotics. Join the AMR movement,” noted Ms. Barcelona.

Following the launch of the WHO Global Action Plan on AMR, the DOH cascaded the program to the local level. Dr. Berba shared the programs launched by DOH – The National Antibiotic Guidelines, The Philippine Action Plan to Combat Antimicrobial Resistance, AMS in Hospitals Manual of Procedures, and AMS in Primary Health Care Manual of Procedures. 

With the threat of the COVID-19 global pandemic, Dr. Berba also noted that the DOH AMS steering committee calibrated the AMS program in order to adapt to new challenges and maximize opportunities to engage and mobilize AMS pharmacists and partners throughout the country.  

“AMR is an urgent and serious global problem. AMS is the one health solution. All of us must be part of the fight against antimicrobial resistance. Together, we have to and will succeed. Together, we have to and will succeed even with COVID.19,” said Dr. Berba.

AMS on the ground

As antimicrobial stewards, pharmacists have a critical role of surveillance, optimizing drug therapy, monitoring and adherence to common pathways guide, and education training through public engagement. To achieve their AMS roles on the ground, they use two interventional strategies: restrictive and persuasive. Through these strategies, they aim to safeguard and ensure the optimal use of antimicrobials and to optimize the clinical outcomes of patients. 

Ms. Sheryll Ann Limson, Philippine Society of Hospital Pharmacist Executive Vice President, discussed that restrictive strategies aim to control the use of antimicrobials by instituting “barriers” to prescribing certain antimicrobials, administration of certain antimicrobials, or after a duration of time. Under restrictive strategies, pharmacists implement the formulary restriction and pre-authorization and 7th day automatic stop for antimicrobial use. 

“We need to take part in our AMS program in our hospitals, especially if we are a hospital pharmacist. If not, we can still be involved in AMS programs still give our share in preventing AMR,” Ms. Limson encouraged fellow pharmacists. 

Meanwhile, Ms. Maria Katrina Rayos, The Medical City AMS Pharmacist, highlighted that 

persuasive strategies aim to persuade health professionals to prescribe appropriately by addressing underlying knowledge deficiencies, attitudes, and/or behavior through active interaction and discussion. Under persuasive strategies, pharmacists use audit and feedback, and point of care intervention. 

“Take little 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 Head Medical Affairs, Patient Access and Public Affairs highlighted, “as a leading global provider of generic antibiotics, Sandoz Philippines is committed to improving global access to medicines and we are equally committed to ensuring the responsible use of medicines. Managing AMR and sustaining AMS, it’s a collaborative effort among all of us, healthcare workers, patients, and the community in general. We are all hands on deck in this global threat. There is no quick fix for this. All our efforts count.”

The Antimicrobial Stewardship (AMS) Program is a concerted effort to improve the appropriate use of antimicrobials in both 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/) to learn more about AMS program in the Philippines. 

ADVT