Antimicrobial Stewardship Case Study

CHAPTER ONE
1.0 INTRODUCTION
1.1 BACKGROUND TO THE STUDY
Pharmacoepidemiological studies attempt to link clinical pharmacology to epidemiology. Drug utilization research is an integral component of pharmacoepidemiology that focuses not only on the medical, but also socio-economic implications of drug distribution and use in a large population, with the primary aim of ensuring the safe, effective and rational drug use. Medical concerns encompasses the actual or potential risks that are inherent in pharmacotherapy, whiles the social component focuses on judicious use of medicines. Economic issues, on the other hand, deals with the cost of drug treatment to the individual and the society (Wettermark et al., 2016; WHO, 2003).
Antimicrobial stewardship
In a country where the time and monetary cost of hospital visit is skyrocketing, many people use community Pharmacies as their first point of call for many ailments, including suspected ‘minor’ infections. They are optimally positioned within the community, are accessible and do not charge for consultation. Within the limits of state laws on healthcare provision, Pharmacist often diagnose and treat disease of common occurrence. In a genuine quest to ensure widespread accessibility of Pharmaceutical care, the regulatory authorities have allowed the proliferation of Private owned retail and wholesale Pharmacies as well as over-the-counter medicine sellers. Many of this Pharmacies cannot afford the services of Pharmacists, and the facilities are often manned by unqualified personnel even though all classes of restricted medicines are on sale. Even in situations where facilities are manned by qualified personnel, pressure from Pharmacy owners and the desire to make huge sales can sometimes negatively influence rational drug selection and use. Basically, the business driven retail pharmacy service has turned many pharmacies into a mere point of sale where one can self-diagnose and walk in to demand a drug including antimicrobials and other prescription only
As explained earlier, this development is attributed indiscriminate use of use of the broad spectrum antibiotics, anticancer therapy and increase in prevalence of immunocompromised infections such as acquired immune deficiency syndrome (AIDS), diabetics and cancer. Moreover, mild to moderate fungal infections such as tinea and foot rot are common in the community, even among people with no known immune deficient disease. For this reason, the development of fungal strains that are resistant to current treatments should be avoided or at least delayed at every cost. Without empiric information about how these medications are dispensed and used in the community, policy makers will be deficient in addressing indiscriminate or irrational use. Beside the development of resistant strains of fungals, many systemic antifungals are associated with some important toxicity and adverse drug reactions (Canada, 2013; Dier & Goyvaerts, 2017; Gupta & Lyons, 2015; Khoza, Moyo, & Ncube, 2017; Kim, Choi, Lee, & Lee, 2017). As a result, misuse can put consumers at risk of adverse drug reactions, especially in the community where drug monitoring and patient follow up is not feasible and many adverse drug reactions go unreported. For example,