Can increasing the number and role of community pharmacists in South Africa help address rising antimicrobial resistance rates, and what are the implications?

Abstract

Antimicrobial resistance (AMR) is a critical issue globally as well as in South Africa, exacerbated by concerns with inappropriate antibiotic use in primary care. This includes prescribers in South Africa with variable dispensing of antibiotics without a prescription. Where this does occur, this is principally for patients with urinary tract infections (UTIs), including those associated with sexually transmitted infections (STIs), and STIs. There is little dispensing of antibiotics without a prescription for self-limiting conditions including upper respiratory tract infections (URTIs). Community pharmacists in South Africa typically offer symptomatic relief first for patients presenting with URTIs unlike prescribers. In view of this, coupled with the key role that community pharmacists played during the COVID-19 pandemic, and the fact that in a number of countries trained community pharmacists can diagnose and dispensed antibiotics for certain infections including UTIs, we believe it is time for the South African Government and Health Authority to review current legislation and expand the services of community pharmacists. An increased number of community pharmacists can also work with prescribers to improve their antibiotic use, building on examples in South Africa and across developing countries. This paper summarises published evidence to promote an increasing role for community pharmacists in the country to reduce AMR, and the suggested next steps to take this debate forward. We believe this is essential if South Africa is to effectively tackle rising AMR rates.