[Implementation of Clinical Research Aimed at Antimicrobial Stewardship]

The implementation of antimicrobial stewardship (AS) is an important issue that pharmacists should promote through cooperation with physicians and other medical professionals. A core strategy for AS is "proactive intervention and feedback" on antimicrobial prescriptions. We evaluated the AS program to optimize antimicrobial chemotherapy in patients with positive blood cultures. For patients with bacteremia, the rate of bacterial disappearance significantly improved in cases in which the feedback based on the antimicrobial susceptibility testing results by the AS team was accepted than in cases in which it was not. Additionally, we attempted to conduct therapeutic drug monitoring for important antimicrobial agents, such as colistin (anti-multidrug-resistant Pseudomonas aeruginosa agent), vancomycin, daptomycin (antibiotics for methicillin-resistant Staphylococcus aureus), and voriconazole (antifungal drug), to optimize dosage and administration for efficacy and safety. For daptomycin, we found a correlation between plasma through concentration and musculoskeletal toxicity in a clinical study. Moreover, direct toxicity to human skeletal cells was observed in an in vitro study using human myoblast cultures. Overall, the results of these studies indicate that further clinical research on AS may aid the improvement of patient efficacy and safety.