Antimicrobial Therapy
Loren Bonner
When infectious disease (ID) clinicians asked ID pharmacists questions, nearly 90% of the 1,518 “curbside” inquiries resulted in clinical management changes as recommended by the pharmacist, according to a study published online on May 15, 2025, in Clinical Infectious Diseases. The curbside fashion refers to phone calls, secure institutional chats, other messaging services, or in-person conversations.
The information pharmacists provided resulted in changes to antimicrobial therapy, dose, duration, or a patient’s monitoring plan, which should come as no surprise since pharmacists with advanced ID specialty training through postgraduate residencies or fellowships provide expertise in antimicrobial pharmacotherapy.
According to the findings, dose adjustments were the most frequent type of clinical management change, occurring in 59% of the interactions, and new antimicrobial agents were implemented in nearly half (47%) of the interactions with pharmacists.
What lead researcher Matthew Davis, PharmD, was struck by the most in compiling the results was that almost a quarter of the interactions led to changes across multiple categories.
“This underscores how often ID pharmacists are sought for their expertise and the significant influence they have on the care patients ultimately receive,” said Davis.
Initially, the research team identified over 100 categories of questions. For brevity, according to Davis, they consolidated many of them.
“The variety of questions ID pharmacists received was striking,” he said. “ID pharmacists are often asked about more than just dosing; they play an active role in diagnostic processes, narrowing differential diagnoses, pairing pathogens with appropriate therapies, and considering patient-specific factors.”
Rich data set
Davis, who works at a tele-infectious disease consulting company providing consult services to community and rural hospitals across the country, said physicians frequently reach out to him for input on managing difficult cases. He began tracking these interactions to identify common themes and topics.
“I have long wanted to document the impact of ID pharmacists on consult services, especially since there is limited literature on this topic despite numerous articles detailing our contributions to antimicrobial stewardship,” Davis said. “I realized that the relationship between ID providers and pharmacists is not unique to my company. ID pharmacists across the field are providing similar consultative support.”
He reached out to colleagues in various settings, including academic medical centers, transplant centers, and community hospitals. With their help, he said the group grew to include 10 ID pharmacists contributing curbside questions.
“This allowed us to gather a rich set of data, which can be leveraged for future projects to explore the nature of these questions and identify areas for education and curriculum development,” said Davis.
Over the 6-month collection period, 1,518 questions were documented. The most common major theme was regimen optimization, followed by dosing, safety/monitoring, resistance, and logistics/coordination.
Gram-negative resistance was the most common subcategory of inquiry, followed by adverse event management, then antimicrobial allergies, outpatient parenteral antimicrobial therapy, regimen selection, and antifungal therapy.
Researchers noted that pharmacists practicing in nonacademic medical settings received more questions per working day than those practicing in academic medical settings.
A key limitation, according to Davis, is that they only captured questions initiated by ID providers, not pharmacist-driven interventions.
“This was intentional to highlight how often ID providers actively seek input from ID pharmacists,” he said. “However, this does not capture the full extent of the pharmacist’s impact, as many interventions originate from the pharmacist directly.”
For example, an ID pharmacist might review cases before rounds and come prepared with recommendations, but this was not captured in the study.
Continuing to prove the impact
By highlighting the importance of ID pharmacists in ID consult teams, Davis said the hope is to justify the need for additional full-time pharmacists in these settings.
“By demonstrating our impact, I believe it becomes clear that ID consult services cannot function optimally without the expertise of ID pharmacists,” he said.
Davis said a colleague has already reached out to say they plan to use this paper to bolster their case for more ID pharmacy support.
“I also hope this paper encourages others to replicate and refine our methodology and include clinical outcomes, which we could not. As a clinical pharmacy community, we know we improve patient care, but it’s crucial that we continue to prove this impact,” he said. ■