 In the 1920s, Alexander Fleming’s discovery of penicillin kickstarted a whole new era of medicine. The impact was such that penicillin was used to treat pneumonia in soldiers on the battlefields during World War 2. And yet a century later in 2020, over 12,000 people die in the UK due to antibiotic resistance with the number increasing to over 700,000 worldwide. So how did antibiotics go from a “miracle drug” that could cure illnesses previously feared by physicians, to a source of concern for doctors worldwide? After the discovery of penicillin in 1928, infections which previously resulted in loss of life were now being adequately treated by antimicrobials. Antimicrobials include antibiotics, antivirals and antifungals. They are vital in preventing and treating infections. An infection arises when a pathogen enters your body and begins to multiply, with a pathogen being a microorganism (such as bacteria) that causes disease. Antimicrobial resistance occurs when microorganisms no longer respond to the antimicrobials designed to kill them. When antimicrobials lose efficacy as a result of antimicrobial resistance, people can succumb to any number of infections. It has become increasingly apparent that antimicrobial resistance poses a real threat to mankind. In fact, antimicrobial resistance has recently been reported by the World Health Organization (WHO) as one of their top 10 threats to global health. Antibiotics are an example of antimicrobials which are used very widely. They have applications in hospitals, community, food production and in veterinary production. The problem is that the more often antibiotics are taken, the less effective they are. This is because bacteria replicate very quickly- for example, E. coli undergoes mitosis every 20 minutes. During this process, mutations can occur. In general, the change is inconsequential but sometimes, the mutation can benefit the bacteria and give it characteristics that prevent it from being affected by an antibiotic. This trait is then favored via natural selection and the mutated strain quickly outnumbers the original strain. This means that when more people use antibiotics, different species of bacteria have a greater chance at developing these resistant traits. When doctors and GPs inappropriately prescribe patients with antibiotics for conditions like sore throat and sinusitis, it puts patients who genuinely need antibiotics at greater risk of harm. A study found that in general around 1 in 5 antibiotic prescriptions are issued inappropriately in the UK and considering how around 18 in 1000 inhabitants are prescribed antibiotics annually, one can imagine how great the number of people misusing antibiotics is. Antimicrobial resistance requires urgent attention. If action is not taken to combat this phenomenon, many modern medicines could become obsolete. Overcoming antibiotic resistance has been a priority for WHO since 2015. World Antimicrobial Awareness Week is an organized effort by WHO to increase awareness of antimicrobial resistance globally and to encourage practices among the general public, health workers and policy makers, which will prevent further emergence and spread of antimicrobial resistance. Antibiotic Guardian is another initiative that is being undertaken to slow the spread of antimicrobial resistance, specifically that of antibiotic resistance. It is a campaign that was launched by Public Health England in 2014 and aims to encourage health and social care professionals, students, educators in the human and animal health sector as well as members of the public to take action against the spread of antibiotic resistance. By pledging to become an Antibiotic Guardian, you choose to perform a simple action which protects antibiotics against the threat of antibiotic resistance. We can all do our part to stop antimicrobial resistance from spiraling out of control. Prescribers, such as doctors, should ensure that they are appropriately prescribing antibiotics and other antimicrobials, whilst patients should ensure that they take these medicines correctly and finish the full course of treatment. Good hygiene and infection control practices, particularly in healthcare settings, can also prevent infection and reduce the need for antibiotics in the first place. Immunization such as vaccinations are also very useful in preventing infections, further reducing the need for antimicrobials. These measures could reduce the use of antimicrobials and in turn, their misuse, such that we can avoid a future where people succumb to infections as they would have prior to the 1900s. Authors: Amelia Ryan and Nusayba Ali References:
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 On to the main part of our trip, meetings. With the help of Dr. Andreia Bruno, we were able to book the “Hercules Room” at Monash University-Parkville Campus. Fully equipped with Zoom capable screens and secret cabinets of food and drinks, student leaders discussed not only different projects but also the sustainability and leadership of PharmAlliance student domain. UNC leaders (Clara Kim, Vraj Patel, Jenny Jin, Ember Lu) and Monash University leaders (Alisha Cloti, Kevin Wu, Brandon Pham) were in attendance, while Ruby Akkad from UCL called in from Toronto due to last minute visa issues.
This was the first time that student leaders were able to meet in person. We realized that the value of this face-to-face communication is vital, as the quality of the conversation was much higher and we were able to accomplish much more action items and structures. Ember and I had created meeting agenda templates beforehand, and each school was in charge of different sections of the meeting. Everyone created agendas before their meeting and came well prepared to host the meeting and guide discussions. The first day was spent mostly discussing PharmAlliance student domain leadership so far. The leaders first drafted a mission statement of PharmAlliance student domain: While aligning with initiatives on the PharmAlliance level at the highest possible extent, collaborate on impactful and challenging pharmacy issues that are common between the US, Australia, and the UK. Then, students discussed about different issues with leadership that came up in effectively leading organizations. Students were able to share their experiences and also give advice on how to overcome obstacles. The next day was spent on discussing the Medication Safety Comic series. We decided on logistics, themes, and different topics we want to be included in the comic series. While discussing all of the topics, we made sure that our end goal was having an element of collaboration in each step. Collaboration sometimes may be inefficient; In fact, there are tasks that could easily be done if it were just done within one campus group. However, the leaders were eager to implement collaborative portions across the project, as that is the main goal of PharmAlliance itself. Also, students and leaders in PharmAlliance truly value the unique international collaboration we are fortunate to be a part of, and wanted to take full advantage. The last day was spent discussion the International Case Competition. Vraj Patel and Brandon Pham led the discussions on assessing what was good versus what could be better compared to last year. At the end of the meeting, the leadership team decided to make create interschool teams - i.e. each team will have students from two different countries! This was an exciting development compared to last year, where teams were composed of students in one school. This was again a decision made with the desire to increase collaboration among students across all three countries. We hope that the International Case Competition becomes a unique opportunity for students to learn about each others’ pharmacy practices. A group of Pharm.D. students received a $10,000 PharmAlliance grant — the first of its kind to be awarded to Pharm.D. students — to support a project promoting medication safety. The project is led by PY3 Clara Kim and PY2 Vraj Patel from the UNC Eshelman School of Pharmacy. It is co-authored by PY3 Ember Lu from the School and students from University College London and Monash University in Melbourne, Australia. Their initiative aims to promote safe use of the three medications most associated with drug errors — opioids, insulins and anticoagulants — through the creation of a comic series that promotes patient education. The comics will be distributed online through social media and offline as posters and fliers posted in community pharmacies in the U.S., England and Australia. “This project will help patients, including those with low health literacy, understand how to take their medications correctly and acknowledge the importance of adherence, while making it fun in the process,” Kim said. Established in 2015, PharmAlliance is an international partnership between the UNC Eshelman School of Pharmacy, University College London and Monash University. PharmAlliance has provided support for research initiatives developed by faculty and Ph.D. students from each of the three schools. This is the first PharmAlliance grant to be awarded to Pharm.D. students. Along with Kim, Patel and Lu, the project’s co-authors include Monash University students Alisha Cloti and Emma Hatherley, and University College of London student Ruby Akkad. “The student leaders of all three schools are very excited and thankful to be the first student group to have received this grant,” Kim said. “This is a very important step for the PharmAlliance student domain.” The students will be mentored by faculty at each school: David Steeb, Pharm.D., M.P.H. at UNC-Chapel Hill, Andreia Bruno, Ph.D. at Monash University, and Oksana Pyzik, M.Pharm. at UCL. The grant will allow the students to develop their project beyond the conceptual stage and travel to Melbourne to discuss their project, as well as ways PharmAlliance can support student initiatives and foster connections between students at each of the schools in the future. Original article found here, published on November 13, 2018 at the UNC Eshelman School of Pharmacy homepage: "Fight the Fakes" is a campaign that aims to raise awareness about substandard medications, which is a big threat to public and patient safety. University College of London students and faculty have been prominent in the Fight the Fakes campaign, with students and faculty members representing at local and global meetings to raise awareness and advocacy for this very important cause. The following editorial was posted on April 2018 on the Lancet Respiratory Medicine. Click here to view the full article. The illegal market in fake medicines is a growing threat and is harming patients the world over—this was the headline of Fight the Fakes, an event at University College London (UCL) on March 16, 2018, which aimed to provoke action on the urgent global issue of falsified and substandard medicines. Pharmacy education at Monash Currently at Monash, our degree pathway is changing. When I began university, I entered the Bachelors of Pharmacy straight after completing high school. This degree is 4 years long and incorporates theory and practical components to prepare us for our future career. Students must work as an intern in either a hospital or community pharmacy to gain additional practice experience in the healthcare world to qualify as a practicing pharmacist. After this, they complete the pharmacy board registration exam to practice as a licensed pharmacist. Beginning in 2017, the course of study shifted to a Bachelor of Pharmacy (Honours) /Masters of Pharmacy which students can still enter directly after completing high school but is now a 5 year program. For the 2017 student cohort and onwards, the intern year is incorporated into their degree instead of at the end of the 4 year degree. Education in pharmacy covers a broad range of topics from physics to ethics as the role of a pharmacist is and must be very flexible. At Monash, we have lectures and lab sessions. We even grow bacteria! There are also practical components where students are encouraged to learn how to practice in real life situations. For example, we have OSCE role plays, tutorials with experienced pharmacists, and practical learning through placements in hospitals or community pharmacies. Pharmacy education at UNC ESoP Here at UNC ESoP, students can start applying for pharmacy school as early as their sophomore year of undergraduate studies. Upon submitting all the requirements, selected students are invited to the school for an interview process, also known as candidate’s day at UNC ESoP. UNC ESoP has recently transitioned from traditional interviews to Mini Multiple Interviews (MMI), which consist of seven stations where students have a limited amount of time to discuss the topic for that specific station. Classes at UNC ESoP are organized to help students develop a strong foundation and basic understanding of pharmacy before branching out to take various elective courses, followed by the final 4th year rotation called APPE. With the mindset that the greatest learning curve occurs when students apply their knowledge, UNC ESoP designed the early immersion program that allows students to gain hands-on experience as early as the summer after their first year in pharmacy school, also known as IPPE. IPPE divided into three different immersion experiences spread throughout the first three years of pharmacy school consisting of Health System, Community, and Direct Patient Care Experience. Finally, after all of these experiences, there’s only one other thing left between us and graduating with our Doctorate of Pharmacy (Pharm.D.) degree, which is the North American Pharmacist Licensure Examination (NAPLEX) that every pharmacy student must pass in order to get their pharmacy license. Once completed, students may continue on their pharmacy career path to either apply for pharmacy positions, residency, fellowships, etc. with their Pharm.D. degree. On behalf of UNC ESoP pharmily, I am sending our warmest greetings from the US! Pharmacy education at UCL In the United Kingdom, all students wishing to register as a pharmacist must study the four-year Master of Pharmacy (MPharm.) program. The MPharm. program at UCL gives students an exciting opportunity to study aspects of chemistry and biology: integrating academic knowledge with clinical concepts in order to provide better patient care. During four years of study at university, the central theme is preparing students for practice by taking a holistic approach to education. The course each year is roughly split into four areas. Students study courses in pharmacy practice, chemistry, formulation science and biology using a variety of different teaching styles and methods such as lectures, practicals, tutorials, workshops and seminars. Concepts become more complex with progression through the course with rigorous academic work as part of the student experience. That is being said, the course is rewarding albeit challenging, and keeps the idea of a patient at the heart of all study. Following graduation, each student must complete a 52-week placement in a clinical environment. Upon completion of the placement, students must sit for a final exam regulated by the General Pharmaceutical Council. Successfully passing this exam will allow students to join the register as a fully qualified, practicing pharmacist. |
