Clinical Pharmacists as Catalysts for Antimicrobial Stewardship: A Narrative Review of Prescribing Appropriateness in Tertiary Care

Author

Shreyas Ramasamudra Venkatesha, Anu Shashidhara, Hithesh Saligrama Rudrachala, Harshith Gowda Mysore Nagendra, Sheba Baby John, Bettaswamy Huraliganaganahalli Vykuntappa, Hanumantachar Joshi

Abstract

 Background: Antimicrobial resistance (AMR) is a critical public health challenge, with tertiary care hospitals serving as focal points for both the proliferation of multidrug-resistant organisms and the need for robust antimicrobial stewardship (AMS). Clinical pharmacists, leveraging their specialized training in pharmacokinetics and microbiology, have become indispensable in optimizing antibiotic prescribing.

Objective: This narrative review evaluates the impact of clinical pharmacist-led AMS interventions on the appropriateness of antibiotic prescribing within tertiary care settings.

Methods: A systematic literature search was conducted across PubMed, Scopus, and Web of Science for studies published between January 2016 and April 2026. Eligible studies included those evaluating pharmacist-led interventions such as prospective audit and feedback, bedside rounds, and digital decision support in adult or pediatric tertiary care populations, reporting quantitative metrics on prescribing appropriateness.

Results: Fifteen studies met the inclusion criteria, seven of which were subjected to detailed evaluation. The synthesis of evidence indicates that pharmacist-led interventions consistently improve clinical outcomes and prescribing quality. Key strategies, including prospective audit and feedback, antibiotic timeout protocols, and pharmacist participation in multidisciplinary rounds, significantly increased guideline adherence, improved drug-bug matching, and facilitated timely de-escalation of therapy. The integration of pharmacists into Computerized Physician Order Entry (CPOE) systems further standardized prescribing practices and reduced cognitive load for clinicians.

Conclusion: Clinical pharmacists are essential catalysts in the success of antimicrobial stewardship. By bridging the gap between microbiological data and clinical decision-making, they shift prescribing paradigms from reactive, empirical choices to evidence-based, precision-targeted therapy. While challenges related to institutional culture and staffing persist, the evidence confirms that embedding pharmacists within the multidisciplinary care team is a high-value strategy to ensure sustainable, high-quality antimicrobial prescribing and to mitigate the broader threats of antimicrobial resistance.

Keywords

Clinical Pharmacist, Tertiary Care, Antibiotic Prescribing, Antimicrobial Resistance, Prospective Audit and Feedback

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