Antibiotic Stewardship
Sonya Collins
idespread misuse and overuse of antibiotics lead to some 2.8 million antimicrobial-resistant infections and 35,000 deaths in the United States every year. Staggering numbers like these underscore the need for more robust antibiotic stewardship programs in hospitals and health systems.
“Pharmacists have a significant yet underutilized role in optimizing antibiotic use, which can lead to improved patient outcomes, reduced resistance, and overall better health care practices,”said Laura Bio, PharmD, coauthor of a study published April 28, 2025, in Antimicrobial Stewardship & Healthcare Epidemiology. The authors of the study sought to characterize the role of pharmacists in antimicrobial stewardship, including their interventions with antibiotic use and the impact of those interventions on subsequent recommendations by pharmacists in antimicrobial stewardship programs. “We advocate for leveraging the expertise of clinical pharmacists and partnership with antimicrobial stewardship programs to enhance stewardship efforts widely.”
A close examination
The study identified 5,277 documented pharmacist interventions on injectable antibiotic orders at Lucile Packard Children’s Hospital Stanford over a 2-year period. The researchers captured all prospective audit and feedback (PAF)—the retrospective evaluation of prescribed antibiotics—performed on injectable antibiotics during that time, as well as which PAFs were followed by new recommendations from the antimicrobial stewardship program pharmacist. Most interventions made by pharmacists involved cefazolin, and it was most often for dose optimization.
Pharmacist intervention on orders of injectable antibiotics was associated with greater likelihood of subsequent recommendations by an antimicrobial stewardship program pharmacist. Among injectable antibiotic orders that had a prior intervention from a pharmacist, PAF led to recommendations from the pharmacist 38% of the time. When there had not been a prior intervention by a pharmacist, 34% of PAFs led to new recommendations. The most common antimicrobial stewardship program recommendation was to discontinue the antibiotic.
While the study authors didn’t expect these results, Bio said, “we believe this difference can be explained based on differences in the types of interventions or recommendations.”
Where pharmacist interventions most often focused on dose optimization, antimicrobial stewardship program pharmacist recommendations were more likely to change or discontinue therapy. The study authors noted that pharmacist recommendations came when therapy was initiated while antimicrobial stewardship program advice came 2 to 3 days later, by which point the infection might have cleared or lab results might have been available, allowing pharmacists to make more precise recommendations.
“Additionally, we hypothesize that the presence of a clinical pharmacist intervention is a marker of antibiotic order complexity that would necessitate ongoing attention, specifically from an [antibiotic stewardship program] pharmacist,” said Bio, who is also lead pharmacist for the Antimicrobial Stewardship Program at Lucile Packard Children’s Hospital Stanford.
Wield the expertise of pharmacists
While pharmacists clearly have a role in optimizing antibiotic use, as evidenced by the study, these clinicians often need more institutional support in order to maximize the impact they can have on antimicrobial stewardship efforts.
The study authors outlined ways in which the health care system could foster a more robust role for pharmacists in antibiotic stewardship, for example, by offering financial support for infectious disease– and antimicrobial-specific continuing education and providing evidence-based institutional guidelines for empiric antibiotic selections.
“Depending on the hospitals’ [antimicrobial stewardship program] structure and relationship with clinical pharmacists, they should consider strengthening those bonds and identifying how to support the clinical pharmacists based on their input and observations regarding antibiotic prescribing,” Bio said. “Clinical pharmacists can promote use of correct antibiotic doses, which can reduce overdosing and adverse effects or underdosing and treatment failure.” ■