The role of pharmacists in antimicrobial stewardship: a scoping review
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20262762Keywords:
Antimicrobial stewardship, Pharmacists, Barriers, Interventions, RecognitionAbstract
Antimicrobial stewardship programs optimize antimicrobial use and combat antimicrobial resistance (AMR). This scoping review examines the roles of pharmacists in antimicrobial stewardship, pharmacist-led interventions, barriers to participation, and recognition mechanisms to enhance pharmacist engagement. The study followed PRISMA methodology, searching databases for literature published between 2010 and 2023. Twenty-four studies met the inclusion criteria. The review reveals that pharmacists undertake a range of functions, including administering pharmacotherapy, monitoring therapeutic drugs, and assessing patients for optimal treatment. Effective pharmacist-led interventions include audit and feedback systems, prior authorization protocols with educational components, real-time alert technologies, and the implementation of evidence-based guidelines. However, key barriers to participation include limited access to resources, ineffective inter-professional communication, and organizational constraints. The review further reveals that recognition mechanisms identified to enhance pharmacist engagement include administrative support, increased involvement in decision-making, enhanced education, and streamlined processes. The review emphasizes the importance of individualizing antimicrobial strategies through interprofessional collaboration, expanding education, implementing clinical decision support systems, fostering an antimicrobial stewardship culture, and supporting research innovations. Addressing the identified barriers and enhancing support mechanisms will maximize pharmacists' contributions to antimicrobial stewardship, ultimately improving patient outcomes.
References
Datta P, Chander J, Gupta V, Mohi GK, Attri AK. Evaluation of various risk factors associated with multidrug-resistant organisms isolated from diabetic foot ulcer patients. J Lab Physicians. 2019;11(01):58–62.
Tricco AC, Lillie E, Zarin W. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-73.
Morrill HJ, Dorobisz M, LaPlante KL. The role of pharmacists in antimicrobial stewardship. In Antimicrobial stewardship: principles and practice (pp. 266– 275). Wallingford UK: CABI; 2017.
Muraki Y. The role of pharmacists in antimicrobial stewardship. Yakugaku Zasshi: J Pharm Soc Japan. 2019;139(4):557–64.
Ahn J, Kim HS, Jeong YM, Lee JH, Lee E, Kim HB. A strategy for pharmacists' participation in an antimicrobial stewardship program and its effect. J Korean Soc Health-System Pharm. 2019;33(4):341–8.
Díaz Granados CA, Abd TT. Participation of clinical pharmacists without specialized infectious diseases training in antimicrobial stewardship. Am J Health-System Pharmacy. 2011;68(18):1691–2.
Gallagher JC, Justo JA, Chahine EB, Bookstaver PB, Scheetz M, Suda KJ, et al. Preventing the post-antibiotic era by training future pharmacists as antimicrobial stewards. Am J Pharmaceutical Edu. 2018;82(6):12-5.
Hamada Y, Ebihara F, Kikuchi K. A strategy for hospital pharmacists to control antimicrobial resistance (AMR) In Japan. Antibiotics. 2021;10(11):1284.
Giuliano CA, Binienda J, Kale-Pradhan PB, Fakih MG. "I never would have caught that before": pharmacist perceptions of using clinical decision support for antimicrobial stewardship in the United States. Qual Health Res. 2018;28(5):745–55.
Yoshinaga N, Hisato A, Kitai M, Hisamitsu Y, Sango H, Yoshida K. Antimicrobial Stewardship and Education: The Role of Pharmacists in the University Hospital. Yakugaku Zasshi. J Pharm Society Japan. 2021;141(11):1253–5.
Shiota A, Mikamo H. Expectations for Pharmacists and Pharmacy Education in AST Activities. Yakugaku Zasshi: Journal of the Pharmaceutical Society of Japan, 2021;141(11):1249–51.
Ishihara S. Clinical Pharmacometrics Research Aimed at Individualized Optimization of Treatment for Drug-resistant Bacteria. YAKUGAKU ZASSHI, 2021;141(12):1289-96.
Khan MU, Hassali MAA, Ahmad A, Elkalmi RM, Zaidi STR, Dhingra S. Perceptions and practices of community pharmacists towards antimicrobial stewardship in the state of Selangor, Malaysia. PloS one. 2016;11(2):e0149623.
Chan AJ, O'Donnell D, Kaasa B, Mathers A, Papaioannou A, Brazil K, et al. Barriers and facilitators of implementing an antimicrobial stewardship intervention for urinary tract infection in a long-term care facility. Canadian Pharmacists Journal/Revue des Pharmaciens du Canada, 2021;154(2):100–9.
Baubie K, Shaughnessy C, Kostiuk L, Joseph MV, Safdar N, Singh SK, et al. Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study. BMJ open. 2019;9(5):e026193.
Gebretekle GB, Haile Mariam D, Abebe W, Amogne W, Tenna A, Fenta TG, et al. Opportunities and barriers to implementing antibiotic stewardship in. low and middle-income countries: lessons from a mixed-methods study in a tertiary care hospital in Ethiopia. PloS one. 2018;13(12):e0208447.
Jones LF, Owens R, Sallis A, Ashiru-Oredope D, Thornley T, Francis NA, et al. Qualitative study using interviews and focus groups to explore the current and potential for antimicrobial stewardship in community pharmacy informed by the Theoretical Domains Framework. BMJ open. 2018;8(12):e025101.
Saha SK, Kong DC, Thursky K, Mazza D. Antimicrobial stewardship by Australian community pharmacists: Uptake, collaboration, challenges, and needs. Journal of the American Pharmacists Association. 2021;61(2):158–68.
Lai WM, Islahudin FH, Ambaras Khan R, Chong WW. Pharmacists' perspectives of their roles in antimicrobial stewardship: a qualitative study among hospital pharmacists in Malaysia. Antibiotics. 2022;11(2):219.
Broom A, Broom J, Kirby, Plage S, Adams J. What role do pharmacists play in mediating antibiotic use in hospitals? A qualitative study. BMJ open. 2015;5(11):e008326.
Owens RC, Shorr AF, Deschambeault AL. Antimicrobial stewardship: shepherding precious resources. American Journal of Health-System Pharmacy. 2009;66(12_Supplement_4):S15-S22.
Czarniak P, Chalmers L, Hughes J, Iacob R, Lee YP, Parsons K, et al. Point-of-care C-reactive protein testing service for respiratory tract infections in community pharmacy: a qualitative study of service uptake and experience of pharmacists. International Journal of Clinical Pharmacy. 2022;44(2):466–79.
Pakyz AL, Moczygemba LR. VanderWielen LM, Edmond MB, Stevens MP, Kuzel AJ. Facilitators and barriers to implementing antimicrobial stewardship strategies: results from a qualitative study. Am J Infect Control. 2014;42:S257-S263.
Ashiru-Oredope D, Doble A, Thornley T, Saei A, Gold N, Sallis A, et al. Improving management of respiratory tract infections in community pharmacies and promoting antimicrobial stewardship: a cluster randomized control trial with a self- report behavioural questionnaire and process evaluation. Pharmacy. 2022;8(1):44.
Baraka MA, Alsultan H, Alsalman T, Alaithan H, Islam MA, Alasseri AA. Health care providers' perceptions regarding antimicrobial stewardship programs (AMS) implementation—Facilitators and challenges: A cross-sectional study in the Eastern province of Saudi Arabia. Ann Clin Microbio Antimicrob. 2019;18(1):1–10.
Tischendorf J, Brunner M, Knobloch MJ, Schulz L, Barker A, Wright MO, et al. Evaluation of a successful fluoroquinolone restriction intervention among high-risk patients: a mixed-methods study. Plos one. 2020;15(8):e0237987.
Rizvi T, Thompson A, Williams M, Zaidi STR. Perceptions and current practices of community pharmacists regarding antimicrobial stewardship in Tasmania. Internation J Clin Pharm. 2018;40:1380–7.
Rizvi T, Thompson A, Williams M, Zaidi STR. Validation and implementation of a national survey to assess antimicrobial stewardship awareness, practices and perceptions amongst community pharmacists in Australia. J Global Antimicrob Resist. 2018;21:28–33.
Burton E, O'Driscoll M, Fleming A. The protected antimicrobial process in a University Teaching Hospital: a qualitative interview study exploring the knowledge, attitudes, and experiences of healthcare professionals. International Journal of Clinical Pharmacy, 2022;44(3):630–40.
Hashmi A, Haq MIU, Malik M, Hussain A, Gajdács M, Jamshed S. Perceptions of community pharmacists regarding their role in antimicrobial stewardship in Pakistan: A way forward. Heliyon, 2023;9(4):25-9.
Wenzler E, Maximos M, Asempa TE, Biehle L, Schütz AN, Hirsch EB. Antimicrobial susceptibility testing: An updated primer for clinicians in the era of antimicrobial resistance: Insights from the Society of Infectious Diseases Pharmacists. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2023;43(4):264–78.
Stojkovic JV, Cvjetkovic S, Matejic B. Adolescents’ right to confidential health care: knowledge, attitudes and practice of pediatricians and gynecologists in the primary healthcare sector in Belgrade, Serbia. Int J Public Health 2020;65:1235–46.
Downloads
Published
How to Cite
Issue
Section
