Quantifying Antimicrobial Disposals at Six Community Pharmacies With Longitudinal Medication Disposal Programs: An Underappreciated Component of a One Health Approach to Antimicrobial Stewardship.

Background: Unused, unwanted, and expired (UUE) medications, including antibiotics, pose a risk to our patients, their families, and our environment. A One Health approach to antimicrobial stewardship calls for stewards to recognize the interconnection between humans and our shared environment. The aims of this project were 2-fold: (1) to educate community members about the importance of responsible medication disposal and (2) to quantify the UUE medications returned to community pharmacies. Methods: Medication disposal programs were established at several community pharmacies in central North Carolina. Periodically, pharmacy school faculty and students visited the participating pharmacies to identify, quantify, and dispose of all UUE medication returns. Medications were deactivated using a Deterra Multi-purpose or Rx Destroyer All-purpose Disposal System and disposed of in accordance with product instructions and applicable laws and regulations. Results: Between November 2021 and May 2023, 6 community pharmacies maintained longitudinal medication disposal programs. In total, 144 084 UUE prescription medication tablets/capsules containing ∼19.3 kg of active pharmaceutical ingredient (API) were disposed of. Antimicrobials accounted for 2.6% of all tablets/capsules and nearly 1.3 kg (6.6%) of APIs. The most disposed antibiotics were doxycycline, amoxicillin, clindamycin, cephalexin, and ciprofloxacin. Conclusions: In this geographically limited study, nearly 1.3 kg of antimicrobial API was disposed of in a span of 1.5 years. Recognizing antimicrobial disposal as an important component of a One Health approach to antimicrobial stewardship, with the goal of expanding these efforts, may influence antimicrobial resistance in our environment.