Vol. 2, Issue 2, Part A (2025)

Background: Antimicrobial resistance (AMR) remains a major threat to global health, primarily driven by the overuse and misuse of broad-spectrum antibiotics in hospitals. Pharmacist-led antimicrobial stewardship (AMS) programs have emerged as effective strategies to optimize antimicrobial therapy and reduce resistance. This study evaluated the impact of a structured pharmacist-led AMS bundle in a tertiary-care hospital on antibiotic utilization, de-escalation practices, and AMR trends.
Methods: A quasi-experimental pre-post interventional design was employed over nine months in a 750-bed tertiary-care teaching hospital. The pharmacist-led AMS bundle consisted of indication verification, 72-hour antibiotic review (“time-out”), intravenous-to-oral (IV-to-PO) switch, and dose optimization. Data were collected from patient charts, electronic prescribing records, and microbiology reports. Antimicrobial utilization was measured as days of therapy (DOT) per 1, 000 patient-days and defined daily doses (DDD) per WHO ATC/DDD methodology. Statistical analyses were performed using t-tests and chi-square tests with significance set at p<0.05.
Results: A total of 420 adult inpatients were analyzed (210 pre- and 210 post-intervention). The AMS bundle resulted in a 20.9% reduction in total DOT (685 to 542 per 1, 000 patient-days) and a 27.7% decline in broad-spectrum antibiotic use. De-escalation at 72 hours increased from 28% to 54% (p<0.001), and IV-to-PO switching rose from 34.7% to 62.3% (p<0.001). The overall physician acceptance of pharmacist recommendations was 82.8%. While short-term AMR surveillance showed only modest declines in resistance proportions among key pathogens (E. coli, K. pneumoniae, P. aeruginosa, S. aureus), the trends were favorable and biologically consistent with reduced antimicrobial pressure.
Conclusion: The pharmacist-led AMS bundle significantly improved antibiotic utilization efficiency, promoted rational prescribing behavior, and enhanced interdisciplinary collaboration. Although measurable AMR reduction requires sustained observation, early improvements in consumption and de-escalation highlight the clinical value of pharmacist-driven interventions. Hospitals should institutionalize such bundles through policy integration, regular audits, feedback mechanisms, and multidisciplinary participation to ensure sustainable stewardship and containment of AMR in healthcare settings.