Sustainable Access to Antimicrobials; A Missing Component to Antimicrobial Stewardship-A Tale of Two Countries

Abstract

Antimicrobial stewardship encompasses a wide range of processes and interventions designed to ensure that antimicrobials are used in the most effective manner. An important, but often neglected process to include is medicine procurement within hospitals, as the untimely administration of antimicrobials has a direct impact on patient care and antimicrobial resistance. A tender system (an open Request for Proposal, RFP) in South Africa is used in the procurement process to supply medicines and pharmaceutical supplies, whereas in the United States, each hospital is responsible for their own procurement processes. Possible key challenges facing countries to ensure a sustainable medical procurement are poor procurement practices, outdated information systems, and unavailability of human resources to support the current system. This article describes the need for adequate pharmacist-led inventory management systems, for sustainable antimicrobial delivery and the successful implementation of antimicrobial stewardship programs. Strategies to improve inventory control and medication delivery for public sector hospitals in South Africa include the development of national pharmaceutical data management standards. Pharmacist involvement in inventory management principles will ensure that antimicrobials are consistently in adequate supply for patient use, hence promoting safe and effective use while decreasing antimicrobial resistance.

Keywords: antimicrobial resistance; antimicrobial stewardship; international collaboration; pharmacist; stockouts.

Figure 1

End-to-end pharmaceutical supply chain steps in SA (34).

Figure 2

Multiple steps in the United States' pharmaceutical supply chain (37).