COUGHS AND COLDS
cent of those involved in the survey felt that there was not much they could do to stop antibiotic resistance.
Pharmacists therefore have an important role in reducing antibiotic resistance in many aspects. Some measures in community practice include improving patient understanding and education, reducing infection incidence and optimising the use of the prescribed antibiotic treatments. Monitoring antibiotic use is also vital for common conditions such as coughs, throat, sinus or throat infections; and we need to assess is the antibiotic that has been prescribed the most appropriate for the infection according to local guidelines, is the dose, route, frequency and duration appropriate for that patient. We, as pharmacists, also need to consider that, if a patient presents a prescription that is post-dated, or is presented several days or weeks after the date of issue, is the antibiotic that has been prescribed still required? Or is it clinically relevant for the condition at all? Counselling is just as crucial with acute antibiotic treatment as that of chronic condition medications, such as completion of the course of prescribed treatment in order to maximise its therapeutic effect, or counselling on drug-drug interactions, particularly that of the fl uoroquinolones and macrolide classes of antibiotics. Additionally, pharmacy teams alongside the pharmacist, also play a role in reducing antibiotic resistance in practice and therefore upon receipt of antibiotics prescription.
WE SHOULD THEREFORE ASK THREE QUESTIONS:
• What has the antibiotic been prescribed for?
• Are there any known allergies?
• If applicable has the patient had their fl u vaccine?
Reassurance surrounding the self- limiting nature of many viral infections is of the highest importance, as is the reinforcement that antibiotics are not usually required, but that self help with over-the-counter medication, closely managing fl uid intake and body temperature and bed rest are most commonly fi rst line as these conditions resolve on their own. Some durations of the conditions commonly seen in practice are shown below, generally only if a patient’s infection persists beyond
40 - SCOTTISH PHARMACIST
approximately fi ve-ten per cent of the population can suffer from the infection. In otherwise healthy individuals, infl uenza is unpleasant, and generally self-limiting resolving around two to seven days; however in at-risk patients - such as those who have co-morbidities, pregnant women, infants and the elderly - the risk of serious complications as a result of the fl u increases up to 18 times that of a healthy individual.
these time frames would they require referral for further examination and possibly antibiotic treatment.
DURATION OF COMMON SELF-LIMITING ILLNESSES WITHOUT TREATMENT
Common self limiting/viral infection
Otitis Media Sore Throat
Common Cold Sinusitis Cough
Typical Duration (Days)
4 7
10 18 21
Further misconceptions about coughs and colds surround the production of coloured mucus or phlegm. Many patients - and even some healthcare workers - believe that any colour other than clear would indicate an infection. However, mucus and phlegm of any colour is produced by the body as a defence mechanism against dirt, pollen or microbes and, as such, is not always a defi nite sign of infection. If the body is actually under attack from microbes, the immune system is capable of fi ghting infections and does not always need antibiotics to do so.
Despite many infections being self limiting, in a lot of circumstances antibiotics are deemed clinically appropriate and are required for therapy. One of the main reasons why patients visit their GP is at the point when their day-to-day activities or sleeping are affected by their seasonal illness or if their illness goes on longer than anticipated. This, in turn, costs GPs valuable time and NHS expenditure, and, while pharmacists are equipped with the clinical understanding surrounding these common conditions, there is very little we can do if an infection is thought bacterial, other than refer to a medical
practitioner to prescribe the required course of antibiotics or treatment. This costs both GPs and patients valuable time and NHS spending; therefore, a recent pilot scheme was trialled across pharmacies in England in order to address these various issues, focusing on bacterial throat infections, and, based on the fi ndings, it could yield an important change for the future of antibiotic prescribing within the UK.
The walk-in service encouraged sore throat sufferers to visit their pharmacist instead of their doctor for an on-the-spot test to decide if they needed antibiotics, so called ‘The Sore Throat Test and Treat Service’. The service was trialled in 35 Boots pharmacies across England and determined if the illness was caused by viral or bacterial origin. This was performed using a throat swab, which measured the sugar levels on the tongue and provided results within fi ve minutes. If a threshold level was reached, the pharmacist was permitted to prescribe antibiotics on the spot for the patient without the need to contact the GP to make an appointment. Of the 360 patients who took part in the scheme, 36 were provided with a prescription for antibiotics: a massive reduction on what is commonly seen in practice, thus reducing GP time, inappropriate antibiotic use and also provides insight into what the future could hold for the pharmacy sector. The throat test is one of eight medical interventions being introduced to help the NHS modernise in the face of demand.
While coughs, colds and other seasonal viral or bacterial infections are general self limiting and have small risk of further complications, the same, however, cannot be said for the fl u. The infl uenza virus is prevalent in Scotland in the colder months and in a normal fl u season
As with coughs and colds, prevention is better than the cure, so the role of the pharmacist is again education about avoidance and the most effective method to do is vaccination against the fl u itself. WHO recommends that a target of 75 per cent vaccination rates should be achieved in the groups identifi ed for administration.
NHS Scotland has offered fl u vaccination services for many years for patients who are over 65 or at risk from further complications. While there has been an increase in the number of fl u vaccinations delivered in Scotland in recent years, in order to achieve the target, set by WHO, the current legislation on delivering fl u vaccinations needs to change. Current legislation set out by the NHS (Scotland) Act 1978 only allows ‘medical practitioners’ to deliver the fl u vaccination on the NHS, a defi nition which does not include pharmacists.
Despite many of Scotland’s community pharmacies already providing private fl u vaccination services outside of the NHS, the Scottish NHS needs to increase public choice and capacity by offering an NHS fl u vaccination service which utilises general practice surgeries and community pharmacies working together to achieve the WHO target. The act should be amended to facilitate the NHS to extend the scope of its vaccination services. NHS England are already developing their community pharmacy network as part of a national NHS fl u vaccination service. Previous research has shown that vaccinations conducted through the community pharmacy sector actually increases vaccination uptake, and is associated with a high level of patient satisfaction. Online networks and platforms should also be utilised to allow the liason of GPs with pharmacists in order to update medical records as to which patients have been vaccinated accordingly. •
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