Assessing Antimicrobial Disposal at Community Pharmacies: A One Health Stewardship Approach

Overview

A longitudinal study at six community pharmacies in central North Carolina quantified unused, unwanted, and expired (UUE) medications returned through ongoing disposal programs. Over 1.5 years, 144,084 prescription tablets/capsules were collected, including nearly 1.3 kg of antimicrobial active pharmaceutical ingredients (APIs), highlighting the importance of responsible disposal in antimicrobial stewardship.

Background

Unused and expired medications, including antibiotics, pose environmental and public health risks by contaminating water sources and promoting antimicrobial resistance (AMR). Traditional disposal methods, such as flushing or trash disposal, contribute to pharmaceutical pollution. Medication take-back programs, especially those based in community pharmacies, offer a practical intervention to reduce environmental contamination. A One Health approach to antimicrobial stewardship emphasizes the interconnectedness of human health and the environment, advocating for responsible antimicrobial disposal to mitigate AMR.

Data Highlights

Key Findings

• Medication disposal programs at six community pharmacies collected over 144,000 UUE prescription tablets/capsules between November 2021 and May 2023.
• Antimicrobials comprised 2.6% of all returned tablets/capsules but accounted for 6.6% of the total active pharmaceutical ingredient weight.
• The top disposed antibiotics were doxycycline, amoxicillin, clindamycin, cephalexin, and ciprofloxacin.
• Despite national efforts, only 13.5% of North Carolina pharmacies had disposal programs as of 2021, contributing to high rates of UUE medications remaining in homes.
• Patients primarily participate in disposal programs due to environmental concerns rather than personal safety or opioid misuse prevention.
• Responsible antimicrobial disposal is a critical component of a One Health antimicrobial stewardship strategy to reduce environmental antimicrobial resistance.

Clinical Implications

Healthcare professionals should actively promote and facilitate medication disposal programs within community pharmacies to reduce environmental contamination with antimicrobials. Educating patients about the environmental impact of improper disposal can increase participation rates. Integrating disposal efforts into antimicrobial stewardship programs supports a One Health approach to combat antimicrobial resistance.

Conclusion

This study demonstrates that community pharmacy-based medication disposal programs effectively collect significant quantities of unused antimicrobials, underscoring their role in environmental stewardship. Expanding such programs is essential to mitigate antimicrobial resistance through a One Health framework.

References

1. Assessing the Disposal of Antimicrobials at Six Community Pharmacies Through Ongoing Medication Take-Back Initiatives, 2023