When Susan Fryters picks something to focus on, she sticks to it.
“I graduated from pharmacy at the University of Alberta in 1990, did my pharmacy residency at the University of Alberta Hospital, and immediately became a drug utilization pharmacist at the Royal Alexandra Hospital, looking primarily at antimicrobials,” she said. “It’s been 30 plus years and that’s still my focus.”
Drug utilization, also called drug stewardship, is the process of evaluating the use of a drug to try and improve its use. Susan has studied hundreds of patient cases to see how effective medications were at treating certain infections.
“The primary purpose is to improve drug use for patients, to make sure that they’re getting the most appropriate therapy,” said Susan. “Is the drug working? Is there something else they could use instead?”
In the world of antimicrobials this takes on a whole new level of importance. Organisms causing common infections have begun to develop resistance to available medications, making those infections harder to treat. A study by the Council of Canadian Academies revealed that in 2018, 5,400 deaths caused by antimicrobial resistance would have been prevented if first-line antimicrobials had still been effective.1 If resistance continues to increase unchecked, by 2050, nearly 14,000 Canadians could die of resistant bacterial infections every year. Resistance is amplified when prescribers over or improperly utilize antimicrobial medications.
“Yes, one antibiotic can be used for many different infections, but it’s extremely important to clarify the diagnosis first,” said Susan. “First, is there an infection? Then, does it need to be treated with antibiotics, and if so, what is the best antibiotic for that patient’s specific infection?”
Susan has dedicated her career to helping healthcare professionals understand what is at stake and educating them to consider this when they are treating and prescribing for patients. During her residency, she met Dr. Edith Blondel-Hill, a specialist in infectious diseases and medical microbiology. In 1993 they collaborated to produce the precursor to Bugs & Drugs, a booklet providing recommendations for appropriate antibiotic use within the Royal Alexandra Hospital. From there, it only got bigger.
“First it expanded to all of Capital Health (now Edmonton Zone), then we went through progressively bigger books and did five print editions, the last one published in 2012,” said Susan. “Then we moved to the online versions, first the website and then the app.”
Bugs & Drugs is now regularly updated and is used across western Canada, while being officially supported by Alberta Health Services, Alberta Health, and the BC Ministry of Health.
Susan and Dr. Blondel-Hill also founded Do Bugs Need Drugs? in 1998, a companion program to educate the public on proper antibiotic use through resources such as the Guide to Wise Use of Antibiotics.
“Yes, one antibiotic can be used for many different infections, but it’s extremely important to clarify the diagnosis first,” said Susan. “First, is there an infection? Then, does it need to be treated with antibiotics, and if so, what is the best antibiotic for that patient’s specific infection?”
– Susan Fryters
Susan is also currently helping to develop antimicrobial stewardship programs within AHS that operate at the hospital level.
“We want a pharmacist, or a team of pharmacists depending on the site, along with an antimicrobial stewardship physician that audits and provides feedback on antimicrobials on a daily basis,” said Susan, “getting real-time feedback to the prescribers about their antimicrobial use and making suggestions for change whenever needed.”
But Susan believes that all pharmacists and healthcare professionals, regardless of whether they work in hospital or community practice environments, should take the time to educate themselves on appropriate antibiotic use.
“Preventing antibiotic resistance is not just about the patient in front of you,” said Susan. “It’s about the societal picture as well, preserving those antimicrobials for other patients and for future generations.”
- Council of Canadian Academies. When Antibiotics Fail: The Expert Panel on the Potential Socio-Economic Impacts of Antimicrobial Resistance in Canada. 2019. ↩︎
