Adherence to Antibiotics

By Wendy Lantaff

The importance of adherence is often discussed regarding long-term medications for chronic conditions, but did you know almost 40 percent of patients on a short course of antibiotic therapy are non-adherent? Non-adherence during antibiotic therapy can result in decreased cure rates, increased health care costs, and the development of antibiotic resistant strains of bacteria. For a pharmacist, there are several easy ways to increase antibiotic adherence.

One way is through education. How many times have patients stopped taking antibiotics because they felt better or because they wanted to save a few for a future infection? Or maybe they were just simply misinformed. Make the dispensing of every antibiotic prescription an opportunity to talk with and educate every patient. Ask open-ended questions during counseling to understand what they already know. You can then reinforce important concepts while educating them about their prescription. Write down the counseling points discussed so the patient can easily refer back to them later. Written instructions, in addition to verbal counseling, have been shown to significantly increase adherence.

Keep it short and simple—the dose, that is. In study after study, the highest rates of adherence are associated with the shortest duration and simplest dosing schedule of antibiotics. Ask your patients if they are going to be able to follow their dosing schedule, especially if the antibiotic prescribed is to be taken three or four times a day or the duration is longer than seven days. If a specific therapy needs to be taken often and the patient knows they are going to have trouble taking some of the doses because they will be at work and won’t have access to food and water, or a place to store their medication, contact the doctor and try to collaborate on a therapy the patient can follow. If a complicated therapy should not be changed, which is the case with Helicobacter pylori eradication, work with the patient to overcome any barriers they foresee, while reminding them that adherence is crucial for success. You, the pharmacist, are first in line to identify and fix adherence issues before they occur.

Follow up. Some studies suggest adherence increases with a follow up phone call from the pharmacist midway through the antibiotic regimen. It has also been shown to increase patient satisfaction, along with giving the patient an opportunity to ask questions regarding medication-related issues that have come up. During follow up phone calls, pharmacists are dispensing advice about managing side effects, recommending over-the-counter medications and non-pharmacological treatments, and referring the patient to their physician when indicated. Rarely do patients seek out this valuable advice when not called. A simple follow up phone call provides the opportunity to enhance patient care and keep your patients on the adherence pathway!

While these adherence activities do take a little time, the results are worth it for both you and your patient. In addition to being healthier, your patient will see their relationship with you strengthening, while continuing to see you as the medication expert, accessible and available. It only takes a minute!

Reprinted with permission from National Community Pharmacists Association in the October 2011 issue of America’s Pharmacist. For more information about NCPA, visit

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