Pharmacists have an important role to play in monitoring antibiotic use through routine clinical screening of prescriptions. They should be mindful of the potential for antibiotic-related drug-drug interactions. Particularly important in this regard are the interactions concerning the fluoroquinolone and macrolide classes of antibiotic.

Screening

When screening antibiotic prescriptions, the following should be considered:

• Is the prescribed antibiotic the most appropriate for the infection according to guidelines?

NICE has developed national antimicrobial prescribing guidelines and most CCGs also have local antimicrobial guidelines.

• Is the choice, dose, route, frequency and duration appropriate?

• Is the prescription a delayed one? Research has shown that a delayed prescribing strategy for some infections reduces antibiotic use compared with immediate antibiotics, without the increased risk of complications, and reduces future expectations for antibiotics.

This strategy is recommended nationally as part of prudent antimicrobial stewardship to reduce antibiotic consumption in primary care for urinary, respiratory and conjunctival infections. Community pharmacists could discuss with GPs joint plans for handling delayed scripts for antibiotics.

If a patient presents with an antibiotic prescription that is post-dated or is being presented several days or weeks after the date of issue, it is important to determine if the same antibiotic is still required. It may be prudent to contact the prescriber if, for example, symptoms have worsened or there are other warning signs.