Antimicrobial stewardship (AMS) refers to any action that promotes responsible use of antibiotics. Pharmacists have a key role in AMS and we know that AMS has key benefits for:

• Patients: by supporting delivery of the right antibiotic to meet the patients’ needs and protecting patients from avoidable harm associated with inappropriate antibiotic use; and
• Society: by ensuring that antibiotics remain effective for the future by limiting the emergence of antimicrobial resistance (AMR)

But have you ever thought about the environmental benefits of AMS?

Antimicrobial resistance (AMR) is inextricably linked to sustainability. The environmental impacts of the manufacture and use of antibiotics are significant.

Applying AMS principles reduces the need for antibiotics and slows the development of AMR. AMS actions, such as vaccination and avoiding the use of antibiotics for conditions where there is no clear benefit, i.e. viral and self-limiting infections, reduces unnecessary antibiotic use. AMS therefore:

• Reduces the overall use of antibiotics;
• Mitigates the environmental footprint of these medicines; and
• Lowers the level of environmental contamination (i.e. antimicrobial residues and antimicrobial resistant organisms in wastewater), through human excretion.

The Carbon footprint of antibiotics

Many of us know that anaesthetic gases and inhalers (in particular metered-dose inhalers), are ‘high emission’ medicines. But many people do not realise that typically the carbon footprint of many antibiotics are rated as high. The medicines carbon footprint formulary gives standardised per dose carbon footprint ratings for thousands of small molecule medicines. This tool reports the carbon footprint rating for amoxicillin 500mg capsules and clarithromycin 500mg tablets as high. It’s important to also recognise that this method does not account for the broader ecological footprint of antibiotics and AMR on the environment.

Medicine Carbon Footprint

The Medicine Carbon Footprint (MCF) formulary gives standardised per dose carbon

footprint ratings for thousands of medicines. In the most up-to-date version of the MCF formulary (February 2025), the carbon footprints per dose are determined using:

• API manufacture and formulation: Standardised estimates of emissions from resource extraction to the finished product based on a semi-automated AI-driven pipeline as described in Taylor et al. 2024;
• Excipient production: Standardised estimates; and
• Packaging manufacture: Standardised estimates

This allows for estimation of medicine carbon footprints per dose, which are categorised into MCF Ratings of LOW, MEDIUM, HIGH, or VERY HIGH, accessible via a free searchable web application, the MCF Formulary.

Taylor et al. make some interesting observations in their 2024 publication (Estimating, standardizing, and stratifying medicine carbon footprints, at scale), which generated standardised medicine carbon footprint for 2,214 products. The products analysed accounted for 2.2 billion NHS England prescribed doses in January 2023. They observed that three antibiotics — amoxicillin, flucloxacillin and penicillin V — contributed 15 per cent of emissions. Amoxicillin 500 mg capsules had the highest monthly emissions of the evaluated products, despite being only the 38^th most prescribed product, and was responsible for 10 000 tonnes CO₂e, equivalent to the monthly emissions of 69 000 cars. They estimate that implementing a recommended 20 per cent antibiotic prescription reduction could save 4200 tonnes CO₂e per month, equivalent to removing 29 000 cars.

The study identifies antibiotics as a major contributor to medicine carbon emissions, and advocates for AMS as a strategy to reduce both AMR and greenhouse emissions.  

Other AMS considerations

Prevention of the development of AMR through appropriate antibiotic use has potential to reduce greenhouse gas emissions in other ways too. Resistant infections often require complex and/ or prolonged healthcare contact which results in significant environmental pollution. Furthermore, optimising antibiotic use in the community could greatly reduce greenhouse gas emissions by preventing a person’s admission to hospital and/ or preventing the spread of infection and subsequent demand for additional medical interventions.

We also know antimicrobial residues and antimicrobial resistant organisms contaminate the environment through human excretion. A recent environmental protection agency research report found widespread occurrence of clinically significant antimicrobial resistant bacteria and antimicrobial resistant genes in wastewater and aquatic environments throughout Ireland. AMS can help reduce the ecological impact of antibiotics on our environment.

AMS actions, undertaken by community pharmacists in their day-to-day role are not only having impact on improving safe effective patient care and combatting AMR, but are also reducing healthcare associated carbon emissions.

“The study identifies antibiotics as a major contributor to medicine carbon emissions, and advocates for AMS as a strategy to reduce both AMR and greenhouse emissions.”

How community pharmacists can help

Examples of AMS actions you can take to support responsible use of antibiotics in your role as a community pharmacist:

• Providing advice when a patient presents with a self-limiting or viral infection so that patients can manage their symptoms appropriately without the need for antibiotics;
• Checking if antibiotic prescriptions align with antibiotic prescribing guidelines, for instance, checking a prescription for the correct dose and duration of treatment against the national antibiotic prescribing guidelines available on antibioticprescribing.ie;
• Determining and verifying factors such an interactions, renal/liver impairment or allergy that may influence the choice of antibiotic;
• Discussing expectations, and benefits versus harms of antibiotics with patients; and
• Promoting vaccination can prevent illness and reduce the need for antibiotics.

Want to learn more?

For more information on antibiotic prescribing, visit the HSE national antibiotic prescribing guidelines on antibioticprescribing.ie For more information about antimicrobial stewardship visit the AMS page on the

If you wish to learn more about community pharmacy’s role in AMS, AMRIC have collaborated with IIOP to develop an AMS elearning module specifically tailored to community pharmacists. The IIOP/AMRIC eLearning module ‘Antimicrobial Stewardship for Community Pharmacists’ is available under courses and events on the IIOP website. The module has been specifically designed to equip you, a community pharmacist, with the knowledge and tools to optimise antibiotic use for the general public and your patients.

You can also join the Pharmacist Antimicrobial Stewardship Network. PAMS-net is a joint collaboration between AMRIC and IIOP. PAMS-net is an all-inclusive network for pharmacists from all professional backgrounds including community pharmacy, hospital pharmacy, education and research, and many other roles. The mission of the PAMS-net is to support pharmacists across all sectors to work towards the common goal of promoting responsible use of antimicrobials in all patients and limiting the emergence of antimicrobial resistance. The vision of the network is to create a more joined up approach to AMS across the pharmacy profession. You can log into the PAMS-net discussion form on PAMS-net webpage on

The HSE also has resources to provide the public with advice on how to treat common conditions at home and when to get help. This includes the HSE common conditions page HSE > conditions > common illnesses, and the HSE A- Z of conditions at HSE > conditions.

References available on request.