Infectious Disease
Sonya Collins
The COVID-19 pandemic shined a light on pharmacists’ relevant skills and expertise in the face of an infectious disease outbreak. Now that the smoke has cleared, pharmacists have largely returned to their prepandemic duties. But a working knowledge of infectious diseases and their treatment strategies continues to be essential across all pharmacy practice settings.
“Infectious disease pharmacotherapy impacts every pharmacist in every specialty; it impacts pretty much everyone across the board,” said Daniel Chastain, PharmD, a clinical associate professor specializing in infectious disease at the University of Georgia College of Pharmacy Albany campus.
Chastain and coauthor Stephanie May, PharmD, an infectious disease telehealth pharmacist at Intermountain Health in Salt Lake City, highlight the critical need for pharmacists’ expertise in infectious disease in their editorial, “Advancing the role of pharmacists in infectious diseases: Fostering critical thinking and collaboration,” which serves as an introduction to an issue of the American Journal of Health-System Pharmacy that is focused on this subject.
“Infectious disease is one of the most challenging topics,” Chastain said, “but one that everyone is going to have some experience with.”
Antimicrobial stewards
Antimicrobial stewardship is an area of significant need in the infectious disease field. Antibiotic resistance is a major global public health threat. Antibiotic-resistant infections kill an estimated 700,000 people a year. If the problem continues unaddressed, WHO predicts deaths could rise to 10 million over the next 25 years.
Pharmacists are needed to educate and consult prescribers on complex antibiotic therapies, monitor patients, educate patients on proper antibiotic use, and spearhead antimicrobial stewardship initiatives.
“Pharmacists are the health care providers best positioned to monitor patients on OPAT [outpatient parenteral antimicrobial therapy], for example, or complex oral regimens that require close monitoring after they leave the hospital,” May said. In small rural and community hospitals in particular, she said, patients may leave the hospital on I.V. antibiotics without much oversight or monitoring.
A voice in clinical controversies
The infectious disease space is fraught with controversies and debates that could benefit from a pharmacist’s perspective.
“Even infectious disease physicians are interpreting the literature in different ways,” May said. “There’s not always a right answer, and I don’t think pharmacists should shy away from participating in those discussions.”
In addition to clinical debates related to antibiotic use and protocols, pharmacists need to take a seat at the table in policy discussions on topics including vaccines and state regulations on HIV testing, prevention, and management.
“There’s a lot of politics in infectious disease,” Chastain said. “With HIV testing and pharmacist-led PrEP, vaccines, screening patients for certain things—politics and the law impact what you can and cannot do.”
Hone your knowledge
As everyone saw firsthand during the COVID-19 pandemic, infectious disease is a dynamic and rapidly changing area, where there are many opportunities for misinformation to spread.
As such, it’s crucial that pharmacists are empowered to talk about infectious disease–related issues. “They need to be willing to discuss it and comfortable discussing it not only with other clinicians, but with patients and the public,” Chastain said.
Willingness to discuss infectious disease–related issues does not require becoming an expert in the field. Rather, it requires being comfortable telling patients and members of the public when you don’t have an answer to a question and that you’ll look it up.
It’s key in these instances to leverage your network and mentors.
“There are so many avenues and platforms for approaching colleagues who can offer you guidance and mentorship,” Chastain said. “Don’t be afraid to reach out to them with questions.”
Pharmacists who want to learn more about topics in infectious disease can first let their practice setting show them where to start. Zero in on the infectious diseases that affect your patient population most.
“If you have access to a dedicated ID pharmacist at your facility, that’s another great place to start,” May said.
The coauthors recommend these online resources to pharmacists who want to hone their knowledge:
Online training modules for clinicians at CDC.gov.
Clinical topic overviews at hospitalmedicine.org.
Various materials at IDstewardship.com.
After consulting these resources, pharmacists should feel more prepared to address infectious disease questions from patients. May said, “I hope that pharmacists will come away with the feeling that infectious disease is a little more approachable than they thought it was before.” ■