Performance cars are not going anywhere. The green party may want them banished, the government them out of their cities and tax man their owners money, but supercars will not die out. They will simply evolve. Making the environmental changes work to its advantage, the hybrid Porsche 918 Spyder has been shown in its full production ready state at Frankfurt for the first time.
Powered by a 4.8 litre V8 and two electric motors the total output for this new breed is 875BHP. Constructed predominately of carbon fibre, the 918 has just become the first road legal car to lap the Nürburgring in under 7 minutes. Clocking in at 6 minutes and 57 seconds it is a full 14 seconds faster than the previous record holder showing the performance benefit of its hybrid system. Couple all of these impressive figures with a 214MPH top speed and 0-62MPH time of just 2.8 seconds and all of a sudden that £657,400 price tag doesn’t seem all that steep.
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According to the Centers for Disease Control and Prevention (CDC), “Antibiotics are a shared resource—and becoming a scarce resource.”1 In 2013, the CDC estimated that more than 2 million illnesses and 23,000 deaths were caused by antibiotic resistance.2 The most modifiable component of complications caused by antibiotic resistance, which leads to increased healthcare costs and poor health outcomes, is antibiotic use. It is estimated that up to 50% of outpatient antibiotic prescriptions are inappropriate,2 and are most often indicated for acute respiratory infections. With these statistics on the rise, antibiotic resistance is one of the world’s most pressing health concerns, with cause to limit misuse and overuse of antibiotics.
The National Action Plan for Combating Antibiotic-Resistant Bacteria is a plan designed to guide the United States in rising to the challenge of combating the pressing threat of antibiotic resistance.3 This plan was developed in response to President Obama’s Executive Order 13676: Combating Antibiotic-Resistant Bacteria. Slowing the emergence of resistant bacteria and preventing resistant infections from spreading is the first goal listed in the plan.3 This goal includes practicing antibiotic stewardship interprofessionally to improve prescribing practices across all settings in healthcare, including the outpatient community pharmacy.
Antibiotic stewardship is defined as promoting the appropriate selection, dose, duration, and route of administration of antibiotics.4 As an antibiotic steward seeking to achieve optimal patient outcomes, limiting adverse events and toxicities, reducing patient care costs, and limiting the drug selection for antimicrobial-resistant bacteria are top priorities.4
The National Association of Chain Drug Stores made a pledge to the CDC stating that they “will integrate stewardship principles into existing programs that provide free or reduced price antibiotics to patients; will develop a new educational model on ‘using point of care tests in pharmacies to promote antimicrobial stewardship and combat antimicrobial resistance’; and will aim to examine the literature supporting outpatient antimicrobial stewardship programs, develop the requisite infrastructure for outpatient clinic and pharmacy stewardship programs, and convene member forums to disseminate the knowledge and showcase implementation of neighborhood stewardship programs.”5
Pharmacists are unique members of the healthcare team; being able to collaborate readily with providers and patients allows for opportunities to aid in combating antibiotic resistance. These opportunities include intervening to prevent unnecessary antibiotic use, promoting vaccinations, and, most important, educating patients and providers. Pharmacists are often the first healthcare practitioner sought by patients for advice regarding infections. In this capacity, pharmacists have a noteworthy responsibility to be a source of information and education, often leading to the avoidance of a physician visit, which can help alleviate the pressure physicians feel from patients to prescribe antibiotics when their use is not truly warranted.6
Listed below are a few opportunities that community pharmacists can take advantage of in their practice settings to contribute to the fight against the war on resistance.
Keeping up to date with current practice guidelines and recommendations for appropriate antibiotic prescribing in adults and children who are seeking care in the community setting is of great importance. By doing so, pharmacists can act as the “gateway practitioner”6 to intervene and prevent unnecessary antibiotic use, and improve antibiotic stewardship. The CDC offers quick reference tables7 for practitioners (see www.cdc.gov/getsmart/community/for-hcp/outpatient-hcp/index.html). Table 1 summarizes the CDC reference table for adult patients.
Source: Centers for Disease Control and Prevention. Adult treatment recommendations. Updated March 4, 2016. www.cdc.gov/getsmart/community/for-hcp/outpatient-hcp/adult-treatment-rec.pdf.
Pharmacists are key healthcare educators in the community. Education is a large component of pharmacist-led outpatient stewardship, as studies8,9 have suggested that patient expectations can influence prescribing habits. Pharmacists have the unique opportunity to include education on antibiotic resistance and stewardship during regular patient interventions already incorporated into their regular workflows.
Such education should include the difference between viral and bacterial infections, explaining why antibiotics will not help when viral infection is suspected, and how improving patients’ knowledge and limiting unnecessary prescribed antibiotics can greatly contribute to the battle the world is facing with antibiotic resistance (Table 2).10
Source: Centers for Disease Control and Prevention. Antibiotics aren’t always the answer. Updated November 14, 2016. www.cdc.gov/features/getsmart/.
When viral infections are suspected by a patient, physician, or pharmacist, appropriate symptomatic care can be recommended by the pharmacist as self-care options to try before seeking antibiotic therapy. Self-care examples for common symptoms associated with viral infections include7:
Cough can be relieved through the use of cough suppressants and lozenges (key active ingredient, dextromethorphan)
Pharmacists are essential in the promotion of currently available vaccines. By being up to date about vaccines, the use of antibiotics can be decreased directly because vaccines help prevent primary infection, and indirectly because vaccines can prevent serious infection of vaccine-preventable illnesses (eg, influenza).6
By screening patients during normal workflow in the community, pharmacists have the ability to identify patients in need of vaccination, and can vaccinate those in need that day because pharmacists are now able to vaccinate in every state.
To slow the progression of antibiotic-resistant bacteria, all healthcare professionals must work collaboratively and contribute as individuals. We all have a responsibility to assist in the war on antibiotic resistance as stewards in each healthcare setting, especially in the outpatient community. As frontline practitioners, pharmacists especially have a role to play as educators and vaccinators.
Without interprofessional treatment protocols for bacterial infections, antibiotics available for use will continue to decrease because of increased antibiotic resistance. It is vital that we collaboratively take a stand against resistance and limit antibiotic use today to prevent larger problems tomorrow.
Centers for Disease Control and Prevention. Appropriate antibiotic use – saves lives, saves money, makes sense. November 17, 2010. www.cdc.gov/getsmart/healthcare/resources/factsheets/pdf/antibiotic-use.pdf. Accessed October 2016.
Centers for Disease Control and Prevention. About antimicrobial resistance. Updated September 8, 2015. www.cdc.gov/drugresistance/about.html. Accessed October 2016.
Centers for Disease Control and Prevention. Leaders committed to antibiotic stewardship. Updated December 7, 2016. www.cdc.gov/drugresistance/federal-engagement-in-ar/stewardship-commitment/index.html. Accessed October 2016.
Centers for Disease Control and Prevention. Adult treatment recommendations. Updated March 4, 2016. www.cdc.gov/getsmart/community/for-hcp/outpatient-hcp/adult-treatment-rec.pdf. Accessed October 2016.
Centers for Disease Control and Prevention. Antibiotics aren’t always the answer. Updated November 14, 2016. www.cdc.gov/features/getsmart/. Accessed October 2016.