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Pharmacy First ‘could increase AMR risk without rapid diagnostics’

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Pharmacy First ‘could increase AMR risk without rapid diagnostics’

Community pharmacies need access to rapid diagnostic tests in order to safely implement the upcoming Pharmacy First service in England without promoting antimicrobial resistance, a group of scientists has warned Rishi Sunak.

In an open letter to the prime minister, a self-styled “coalition” of 14 academics said that while they “applaud” the decision to give community pharmacists powers to “prescribe medicines for some common illnesses in order to reduce GP workload, cut waiting lists and alleviate pressure on the NHS,” the Government should be mindful of associated AMR risks.

“Unless it is implemented with due consideration given to antibiotic resistance, such an initiative could lead to unintended consequences that would reverse the gains it makes,” they added.

The scientists pointed out that of the seven Pharmacy First conditions, three – ear infections, sinusitis and sore throats – can be the result of viruses or bacteria, and that the inappropriate use of antibiotics could drive the “public health crisis” of antibiotic resistance.

Calling on the use of “accurate and rapid diagnostics” to inform pharmacist prescribing, they said failure to tackle AMR could cause millions of deaths a year and “jeopardise the safety of procedures we rely on in modern medicine”.

Giving pharmacists access to tests and relevant training “will require upfront investment and may not yield immediate results,” they said, but added: “Implementing the initiative whilst accounting for antibiotic resistance gives it the best chance of avoiding extremely serious unintended consequences and simultaneously provides an opportunity to strengthen the UK’s healthcare innovation ecosystem as well as the NHS.”

They pointed to a pilot study demonstrating that showed community pharmacists could, when “armed with a rapid diagnostic test,” treat patients with respiratory tract infections while “greatly reducing” the number of inappropriate antibiotic prescriptions.

They added: “The use of rapid diagnostic tests has become the new normal during Covid-19, and we have a timely opportunity to capitalise on this by expanding their use in the context of other infections.”

Recent research has shown that the Pharmacy Quality Scheme in England has incentivised antimicrobial stewardship in community pharmacies.

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