Pharmacists' perspective of antimicrobial stewardship programmes in the primary care setting in São Paulo

Antimicrobial stewardship programmes (ASPs) are essential to tackling antimicrobial resistance, particularly in primary care, where most prescribing occurs. Pharmacists play a key role in ASPs through patient education, prescription monitoring, and promoting appropriate use. This study assessed the status of ASPs in primary healthcare centres (PHCs) in São Paulo state from the pharmacists' perspective.

A cross-sectional survey was conducted between June 2023 and January 2024 among pharmacists working in PHCs across São Paulo. The questionnaire, based on CDC and ANVISA guidelines, addressed demographics, PHC characteristics, ASP activities, and pharmaceutical interventions. Descriptive statistics were used.

Of 201 responses, 189 were eligible, representing PHCs in 68 cities. Most pharmacists (75%) had postgraduate education, and 70% worked in centres serving over 500 patients. Although 79% of PHCs used electronic medical records, only 32% had written ASP policies and 29% monitored antimicrobial use. Diagnostic resources were limited; respiratory virus tests were the most available (43%). Educational activities on antimicrobial use occurred in 26% of PHCs. Pharmaceutical interventions were reported by 77% of pharmacists, mainly related to dosage (54%) and treatment duration (25%), with high prescriber acceptance (≥80% in 34% of cases).

This study identified strengths and gaps in ASP implementation across PHCs. While improvements were seen in infrastructure and pharmacist training, key limitations remain in policy development, diagnostics, prescriber support, and public education. We recommend: (1) establishing local ASP policies, (2) expanding access to rapid diagnostics, (3) continuing education for prescribers and pharmacists, and (4) public awareness campaigns tailored to primary care.