Dighriri Ibrahim M, Alnomci Bayader A, Aljahdali Mashael M, Althagafi Hadeel S, Almatrafi Raghad M, Altwairqi Wasan G, Almagati Ashwaq A, Shunaymir Abdulaziz M, Haidarah Ghadeer A, Alanzi Mohmmad H, Hadadi Abdullatif A, Suwaydi Hind M, Aqdi Maha J, Alharthi Hamed N, Alshahrani Amaal F
Department of Pharmacy, King Abdulaziz Specialist Hospital, Taif, SAU.
Faculty of Pharmacy, Qassim University, Qassim, SAU.
Cureus. 2023 Dec 8;15(12):e50151. doi: 10.7759/cureus.50151. eCollection 2023 Dec.
Antimicrobial resistance (AMR) is a major global health threat, increasing deaths and healthcare costs. Antimicrobial stewardship programs (ASPs) have been implemented to optimize antibiotic use and curb resistance. This systematic review aimed to summarize evidence on the role and impact of pharmacists in hospital ASPs. A comprehensive literature search was conducted across databases to identify relevant studies published from 2016 to 2023. Twenty-four studies met the inclusion criteria, comprising global observational and randomized clinical trials. Pharmacists performed various stewardship activities, including prospective audits, formulary management, de-escalation, guideline development, and education. Pharmacist-led interventions significantly improved antibiotic prescribing, reduced unnecessary antibiotic use, optimized therapy, and enhanced outcomes. Multiple studies found that pharmacist reviews decreased the time to optimal antibiotics and improved guideline compliance without affecting readmissions or revisits. De-escalation programs safely reduced antibiotic duration and length of stay. Acceptance rates for recommendations were high. Pharmacist stewardship curbed overall antibiotic use, costs, and duration across hospital departments, leading to savings. While most studies showed positive impacts, fewer detected significant changes in resistance or mortality over short periods. More research is needed, but current evidence demonstrates that pharmacists play critical roles in ASPs, leading to improved antibiotic use and patient outcomes. These findings support integrating pharmacists into stewardship activities, significantly extending programs to ambulatory settings.
抗菌药物耐药性（AMR）是全球主要的健康威胁，会增加死亡人数和医疗成本。抗菌药物管理计划（ASP）已被实施以优化抗生素使用并遏制耐药性。本系统综述旨在总结药师在医院抗菌药物管理计划中的作用和影响的证据。我们在多个数据库中进行了全面的文献检索，以识别2016年至2023年发表的相关研究。24项研究符合纳入标准，包括全球观察性研究和随机临床试验。药师开展了各种管理活动，包括前瞻性审核、处方集管理、降阶梯治疗、指南制定和教育。由药师主导的干预措施显著改善了抗生素处方，减少了不必要的抗生素使用，优化了治疗，并改善了治疗结果。多项研究发现，药师的审核缩短了使用最佳抗生素的时间，提高了指南依从性，且不影响再入院或复诊情况。降阶梯治疗方案安全地缩短了抗生素使用时间和住院时间。建议的接受率很高。药师的管理控制了整个医院各科室的抗生素总体使用、成本和使用时间，从而节省了费用。虽然大多数研究显示出积极影响，但较少有研究在短期内发现耐药性或死亡率有显著变化。仍需要更多研究，但目前的证据表明，药师在抗菌药物管理计划中发挥着关键作用，可改善抗生素使用和患者治疗结果。这些发现支持将药师纳入管理活动，大幅将计划扩展到门诊环境。
