Abstract
Pakistan is facing a significant issue with the rise of antimicrobial resistance, due to inappropriate antibiotic prescriptions, lack of diagnostic stewardship and poor hospital-level antimicrobial stewardship programs. A pharmacist-led antimicrobial stewardship program was implemented to assess the effect on antibiotic prescribing, use of antibiotics, and clinical outcomes for patients with infectious diseases at Jinnah Postgraduate Medical Centre, Karachi. The study employed a quasi-experimental pre-post intervention design, with a 6-month baseline period and 6-month post-intervention period. The study involved 300 adult inpatients (150 patients in each phase). Prospective prescription review, pharmacist feedback, dose optimization, de-escalation of antibiotics based on culture and sensitivity results, guideline-based prescribing support, education of health-care professionals and restriction of some broad-spectrum antibiotics were the basis of the intervention. After the pharmacist-led stewardship program was introduced, inappropriate antibiotic prescribing fell from 52% to 24% and culture-based therapy rose from 32% to 54%. Uncultured therapy decreased from 68% to 46%, and use of broad-spectrum antibiotics from 61% to 39%. There were also improvements in clinical outcomes, with average hospital stay decreasing from 8.5 ± 2.1 days to 7.1 ± 1.8 days, mortality from 14% to 8%, infection cure from 61% to 79%, and 30-day readmission from 18% to 11%. Antibiotic use decreased from 78 to 58 DDD/100 patient-days. In the intervention period, 420 pharmacist recommendations were made with 82% acceptance by physicians. This study shows that pharmacist-led antimicrobial stewardship can significantly improve antibiotic prescribing practice, decrease inappropriate antibiotic use and improve patient outcomes in a high-burden tertiary care setting. Expanding pharmacist-led stewardship programs could enhance the control of infectious diseases and aid national efforts to combat antimicrobial resistance in Pakistan.