Evolution of pharmacist roles in antimicrobial stewardship: A 20-year systematic review

Whilst pharmacists are recognized as key contributors to antimicrobial stewardship (AMS) programs, the extent of their participation varies in different countries. We report a systematic review of pharmacist roles in AMS over 20 years.

A systematic review of the literature describing pharmacist-led or driven AMS and its outcomes published in English between January 01, 2000, and June 30, 2020, was conducted across the main databases for research publication.

The analysis included 111 papers, of which 77.5% (86/111) were from high-income countries (HIC) predominantly from the USA. While pharmacist-led or driven AMS interventions were reported only from HICs in the early 2000s, the review found a progressive rise in such studies from all income settings with audit and feedback being the most frequent intervention reported. Between 2016 and 2020, studies on pharmacists-led or driven outpatient AMS and interventions related to beta-lactam or penicillin allergy were reported from HICs. Key outcomes reported include improved appropriateness of antimicrobial therapy and decreased consumption of antimicrobials.

Existing evidence demonstrates the positive impact of pharmacists' involvement in AMS. There needs to be a concerted effort in facilitating pharmacist roles in AMS across all countries, irrespective of income setting.