By the bioMérieux Connection Editors
Interviewing: Debra Goff, PharmD, FCCP, Infectious Disease Specialist and Professor of Pharmacy Practice at Ohio State University Wexner Medical Center
Dr. Debra Goff has spent more than 30 years practicing in infectious diseases and antimicrobial stewardship around the globe. Throughout her career, she has seen the use of antibiotics—and antimicrobial resistance (AMR)—evolve. “When I started my career, the challenge was, ‘Which antibiotic am I going to use?’ because we had so many effective ones to pick from. That story has changed 100%. Now [we have situations where] there are no effective antibiotics or limited effective antibiotics and profound antibiotic resistance.”
Over the past few decades, patients have often taken antibiotics for granted, especially drugs like azithromycin and ciprofloxacin. Patients frequently request antibiotics when they are not needed, contributing to the development of antimicrobial resistance.
“The overuse of antibiotics, quite honestly, is not just because physicians prescribe them too much. Patients pressure us for them,” says Dr. Goff. “There’s a general perception that antibiotics are safe and benign. ‘Just in case, let me have some, because I don’t have time to be sick.’ And now we’ve come to the point where we have untreatable infections.”
Antimicrobial Resistance is Today’s Problem, Not Just Tomorrow’s
The most familiar statistics about antimicrobial resistance are often those associated with the future, for example, that there will be more than 10 million deaths attributed to AMR annually by 2050.
That figure, though ominous, is too far into the future for many people to appreciate its true gravity. “You have to make the message real-time,” says Dr. Goff. Antimicrobial resistance is a major problem in 2020—every 45 seconds, a person dies from an antibiotic-resistant infection, and treatment options are becoming more and more limited.
Dr. Goff believes that the COVID-19 pandemic has provided a real-life example of the type of threat that AMR poses to our health. “This is what happens when you have an untreatable infection—people die,” she says. Despite the tremendous pain that COVID-19 has caused around the world, one silver lining is that the pandemic has helped act as an educational opportunity on the importance of infection prevention practices. “That’s probably going to be the one gigantic positive out of COVID—the entire world realizes how important it is to have good hand hygiene, to not come to work when you have symptoms of viral illnesses. The pandemic demonstrates the importance of infection control and responsible use of antibiotics.” This is true for patients and healthcare professionals alike.
Improving Antimicrobial Stewardship Globally
While the COVID-19 pandemic has helped the general public better understand infection prevention, Dr. Goff knows that there is still an enormous amount of work to be done to curtail antimicrobial resistance around the world. She emphasizes that pharmacists in particular can be utilized more in stewardship initiatives, as they have a direct impact on patient care, whether they work in advanced hospital environments or in low and middle-income countries.
“Part of the challenge in many countries is that pharmacists are not at all engaged in this discussion because they are in very traditional dispensing roles,” said Dr. Goff. “We need to learn to work together. We need physicians, pharmacists, and nurses engaged in antibiotic stewardship.”
Organizations like the International Pharmaceutical Federation (FIP) empower pharmacists to get involved in stewardship, offering educational AMR resources and recently establishing a Commission on Antimicrobial Resistance. “It’s an amazing opportunity for global engagement of pharmacists. We are going to change the picture of a pharmacist being solely a dispenser of medicine. We’re going to empower them to be part of the solution and not the problem,” says Dr. Goff, who works closely with FIP.
Additionally, Dr. Goff notes that rapid diagnostics have been a game changer in the management of infectious diseases and that pharmacists have an opportunity to help interpret lab results to inform appropriate treatment options. “Pharmacists can work hand-in-hand with the micro lab and the medical team and teach them how to apply rapid diagnostic test results. It’s an area that is constantly changing,” she says.
The impact pharmacists can have on appropriate antibiotic prescribing is significant. “I think the pharmacist is the glue of the [antimicrobial stewardship] program. When you empower someone in a role that directly impacts the care of patients, it’s very powerful—and it works.”
Opinions expressed in this article are not necessarily those of bioMérieux, Inc.