From the Guidelines
The Evolution of Infectious Diseases Pharmacy as a Specialty has been significantly shaped by the growing need for antimicrobial stewardship, with pharmacists playing a crucial role in optimizing antimicrobial therapy and reducing inappropriate antibiotic use. The history of infectious diseases pharmacy as a specialty began in the mid-20th century, emerging from the rapid development of antimicrobial agents following the discovery of penicillin in 1928 1. Initially, pharmacists served primarily in dispensing roles, but as antimicrobial resistance became increasingly problematic in the 1970s and 1980s, the need for specialized knowledge in infectious diseases pharmacy became apparent. The first formal recognition came in 1988 when the American Society of Health-System Pharmacists established a specialized residency in infectious diseases. This specialty evolved to address the complex pharmacokinetics and pharmacodynamics of antimicrobial agents, the rising threat of multidrug-resistant organisms, and the need for antimicrobial stewardship programs.
Today, infectious diseases pharmacists are integral members of healthcare teams, providing expertise in optimizing antimicrobial therapy through dose adjustments based on patient-specific factors like renal function, interpreting susceptibility data, and managing drug interactions. They lead antimicrobial stewardship efforts, which have been shown to reduce inappropriate antibiotic use by 20-40%, decrease healthcare costs, and improve patient outcomes, as seen in studies such as the one by White et al 1, which demonstrated a 32% decrease in total parenteral antibiotic expenditures and increased percentages of susceptible gram-negative isolates.
Some key strategies in antimicrobial stewardship include preauthorization and prospective audit and feedback (PAF), both of which have been associated with significant reductions in antibiotic use and resistance, as well as decreased rates of Clostridioides difficile infection (CDI) 1.
- Preauthorization has been shown to reduce the use of restricted agents and associated costs, with advantages including the reduction of unnecessary or inappropriate antibiotics, optimization of empiric choices, and decreased antibiotic costs.
- PAF interventions have also been effective in improving antibiotic use, reducing antibiotic resistance, and reducing CDI rates, with advantages including increased visibility of antimicrobial stewardship programs, more clinical data available for recommendations, and greater flexibility in timing of recommendations.
The specialty continues to evolve with new challenges including emerging pathogens, novel antimicrobial development, and the integration of rapid diagnostic technologies. Board certification through the Board of Pharmacy Specialties, established in 1994, has further legitimized the specialty, with over 2,000 pharmacists now certified in infectious diseases pharmacy. The field represents a critical component in the global fight against antimicrobial resistance and continues to expand its scope into areas like outpatient antimicrobial therapy, HIV management, and global health initiatives. The implementation of antimicrobial stewardship programs, such as those recommended by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America 1, is crucial in addressing the complex issues surrounding antimicrobial use and resistance.
From the Research
The Evolution of Infectious Diseases Pharmacy as a Specialty
The field of infectious diseases pharmacy has undergone significant transformations over the years, driven by advances in medical science, changes in disease patterns, and the need for specialized care.
- The integration of specialty pharmacy services with existing outpatient clinical pharmacy services has been shown to optimize the care of patients with human immunodeficiency virus (HIV) infection 2.
- This integration allows for closed-loop medication management, including medication education, prescription fulfillment, assistance with medication access, and treatment monitoring.
Historical Context
The specialty of infectious diseases in the United States has a rich history, with interest in the field waxing and waning over the years.
- In the past, infectious diseases were so prevalent that a special interest in the field was not considered necessary, but with declining mortality and morbidity from infections, interest in infectious disease flagged 3.
- However, the appearance of newly recognized infectious disease syndromes, advances in microbiologic and immunologic understanding, and the development of effective therapeutic and preventive agents have led to a renewed interest in infectious disease.
Current Developments
In recent years, there has been a growing recognition of the importance of infectious diseases pharmacy expertise in the success of antimicrobial stewardship efforts.
- The development of standardized clinical infectious diseases pharmacy care delivery and antimicrobial stewardship program management has been shown to optimize care delivery and address disparities in clinical services 4.
- This includes the implementation of stewardship initiatives, formulary management, and guideline and document control, as well as serving as a resource for prescribers and pharmacy staff and leadership.
Standardization of Care
The standardization of infectious diseases pharmacy care delivery is crucial for ensuring consistent patient care across different geographic locations and socioeconomic statuses.
- A hybrid model of remote and in-person coverage has been shown to address disparities in clinical services, education, and antimicrobial stewardship management 4.
- This model also helps to reconcile complexities such as care gaps during leave and maintains the minimum expectations of every infectious diseases pharmacist.
Table: Evolution of Infectious Diseases Pharmacy
| Year | Development | Reference |
|---|---|---|
| 1987 | Renewed interest in infectious disease due to newly recognized infectious disease syndromes and advances in microbiologic and immunologic understanding | [3] |
| 2014 | Integration of specialty pharmacy services with existing outpatient clinical pharmacy services for patients with HIV infection | [2] |
| 2024 | Development of standardized clinical infectious diseases pharmacy care delivery and antimicrobial stewardship program management | [4] |