Partnering with pharmacists in responsible prescribing

Dermatologists and other physicians can partner with pharmacists to promote responsible antibiotic prescribing, experts say. 

“I think pharmacists are a very important partner in the effort to improve antibiotic use, whether we’re talking about prescribing for dermatologic conditions or respiratory infections,” says Hicks, D.O., an infectious disease doctor and medical director of the CDC’s Get Smart: Know When Antibiotics Work campaign. “… pharmacists are very accessible to the general public. I think in terms of dermatologists and pharmacists working closely together, the pharmacists can be a great resource for providing over-the-counter recommendations to the general public regarding treatment of skin conditions. Many pharmacists are also very knowledgeable about the issue of antibiotic overuse and can help identify opportunities to improve antibiotic use and limit unnecessary use.”

Kevin Snell, R.P.H., B.S., pharmacist in charge, ShopRite, Flanders, NJ, says he continues to see what he calls antibiotic overprescribing by dermatologists. Some of the more popular oral prescriptions, he says, include doxycycline and minocycline, as well as topicals DUAC (clindamycin phosphate and benzoyl peroxide, Stiefel Laboratories) and Acanya (clindamycin phosphate and benzoyl peroxide, Valeant Dermatology) 

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Where Mr. Snell thinks pharmacists would have the greatest impact on dermatologists’ prescribing is in navigating formularies. Snell says what happened recently at ShopRite was a perfect example of a missed opportunity in the effort to curb antibiotic use. Snell was off during the weekend, when another pharmacist received a script for Epiduo [adapalene and benzoyl peroxide, Galderma], which was not on the patient’s plan. The pharmacist left a message for the prescribing doctor to change the prescription to something that was on the patient’s formulary.

“There was an opportunity there, where if the pharmacist had said, ‘We can use the generic adapalene and combine it with a benzoyl peroxide,’ that would be on the formulary and still be non-antibiotic…,” Snell says. “But the pharmacist just said we just have to change it to something on formulary. So, the doctor faxed me back on Monday and said to change it to Duac, which is a topical antibiotic.”

Opportunities for interaction

Opportunities for interaction

The opportunity for pharmacists to interact with dermatologists happens often, he says.

“A lot of dermatologic products are expensive or non-formulary or they require prior authorization. We do have a lot of cases where we have to call the derms back. If we were to make an impact, that’s where it would be,” Snell says.

Helen Kizler, PharmD, a compounding pharmacist and owner of Great Earth Compounding Pharmacy in Los Angeles, Calif., says she and her staff help prevent antibiotic overuse by customizing antibiotic dosages.

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“This way the patient only takes the dosage needed for their body weight and symptoms and are not limited to what is commercially available,” Dr. Kizler writes in an email to Dermatology Times. “We work with dermatologists to monitor patient's usage of antibiotics and recommend alternatives to antibiotics for patients needing longer duration of treatment. By working closely with dermatologist, we can customize ingredients to help treat the cause of the problem not just mask the symptoms.”