EVOLUTION OF PHARMACISTS’ ROLES IN ANTIMICROBIAL STEWARDSHIP AND ITS OUTCOMES OVER 20 YEARS: A SYSTEMATIC REVIEW FROM HIGH-, MIDDLE- AND LOW-INCOME COUNTRIES

Abstract

Intro: Pharmacists are recommended as one of the key contributors to antimicrobial stewardship (AMS) programmes, however, the extent of their participation varies in different countries. We report the evidence of pharmacists’ roles in AMS and its outcomes over 20 years in High-, Middle- and Low-income countries. Methods: A systematic review of the literature was conducted using the main databases for research publications. Studies describing pharmacist-driven or led AMS and its outcomes published in the English language between January 1999 and June 2020 from high-, low-, and -middle-income countries were included. Review of papers (title-abstract and full text) occurred independently by three reviewers and any disagreements were reviewed and discussed with a fourth reviewer. Findings: A total of 118 studies were included in the final analysis of which 78% (92/118) were published from high-income countries (HICs) with 74% (68/92) from the United States of America. The review found a progressive rise in pharmacist- led or driven AMS from all income settings. Across the variety of AMS interventions reported, audit and feedback was the most frequent intervention by pharmacists resulting in improved appropriateness of antimicrobial therapy and reduced consumption of antimicrobials. Whilst the involvement of infectious diseases trained pharmacists were reported, predominantly in HICs, various studies from across the globe highlighted the support provided by the wider AMS team to pharmacist's contributions to the program. Conclusion: Pharmacists’ involvement in AMS has been shown to positively impact antimicrobial prescribing. The increasing evidence of pharmacist-led or driven AMS is predominantly reported in the HICs and gradually evolving in middle- and low-income countries. There needs to be a concerted effort in facilitating pharmacists' roles in AMS across all countries, irrespective of income setting.