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Antimicrobial Resistance and Antimicrobial Stewardship in Community and Hospital Pharmacy Practice: A Scoping Review
Subject area: Biological & Medical Sciences · Area of research: Pharmacy
DOI: https://doi.org/10.64388/IREV8I9-1719514
Abstract
Background: Pharmacists in the community and hospital are becoming more and more involved in antimicrobial stewardship (AMS) and antimicrobial resistance (AMR) increases the disease burden, affects all countries, and is one of the most severe global public health problems. However, the extent of the roles, interventions and reported outcomes of the pharmacist varies throughout the various settings of care and has not been consistently mapped. Objective: To summarise and interpret up to date evidence of the use of AMR and AMS in community and hospital practice, summarise the nature of intervention by a pharmacist, the determinants of satisfaction with AMS and AMR implementation including factors related to the clinical, behavioural and organisational outcomes reported. Methods: Peer-reviewed literature until 2024 was mapped according to a PRISMA-ScR flow diagram, guided by a scoping framework developed by Arksey and O’Malley. Twenty sources from high-, middle- and low-income settings were identified, mapped by setting and by type of intervention, and further by outcome domain. Results: The interventions for AMS were grouped into four categories: educational, persuasive, restrictive and structural. The interventions at hospitals were most successful overall in reducing antimicrobial use and antimicrobial treatment duration without impacting safety, while community interventions resulted in better appropriate dispensing, public awareness, and referring practices; interventions at discharge were inconsistent. Hospital interventions were most successful in reducing antimicrobial use and duration of treatment without compromising safety, while community interventions were effective in improving appropriate dispensing, public awareness, and referral; interventions at discharge were inconsistent. Determinants of implementation which were consistent across all clusters were knowledge gaps, remuneration, regulatory ambiguity and interprofessional trust. Conclusion: Evidence supporting pharmacists' role in strengthen stewardship along the care continuum exists, however is fragmented and biased toward high income hospital settings. To ensure AMR is managed and controlled as a consequence of its contribution to the practice, standardisation of reporting of outcomes, sustainable funding and increased scope of practice frameworks are required.
Keywords
Antimicrobial Resistance, Antimicrobial Stewardship, Community Pharmacy, Hospital Pharmacy, Pharmacist-Led Interventions, Scoping Review
How to cite this paper
@article{1719514,
author = {Harry S Patel},
title = {Antimicrobial Resistance and Antimicrobial Stewardship in Community and Hospital Pharmacy Practice: A Scoping Review},
journal = {Iconic Research And Engineering Journals},
year = {2025},
volume = {8},
number = {9},
pages = {2050-2064},
issn = {2456-8880},
url = {https://www.irejournals.com/formatedpaper/1719514.pdf},
abstract = {Background: Pharmacists in the community and hospital are becoming more and more involved in antimicrobial stewardship (AMS) and antimicrobial resistance (AMR) increases the disease burden, affects all countries, and is one of the most severe global public health problems. However, the extent of the roles, interventions and reported outcomes of the pharmacist varies throughout the various settings of care and has not been consistently mapped.
Objective: To summarise and interpret up to date evidence of the use of AMR and AMS in community and hospital practice, summarise the nature of intervention by a pharmacist, the determinants of satisfaction with AMS and AMR implementation including factors related to the clinical, behavioural and organisational outcomes reported.
Methods: Peer-reviewed literature until 2024 was mapped according to a PRISMA-ScR flow diagram, guided by a scoping framework developed by Arksey and O’Malley. Twenty sources from high-, middle- and low-income settings were identified, mapped by setting and by type of intervention, and further by outcome domain.
Results: The interventions for AMS were grouped into four categories: educational, persuasive, restrictive and structural. The interventions at hospitals were most successful overall in reducing antimicrobial use and antimicrobial treatment duration without impacting safety, while community interventions resulted in better appropriate dispensing, public awareness, and referring practices; interventions at discharge were inconsistent. Hospital interventions were most successful in reducing antimicrobial use and duration of treatment without compromising safety, while community interventions were effective in improving appropriate dispensing, public awareness, and referral; interventions at discharge were inconsistent. Determinants of implementation which were consistent across all clusters were knowledge gaps, remuneration, regulatory ambiguity and interprofessional trust.
Conclusion: Evidence supporting pharmacists' role in strengthen stewardship along the care continuum exists, however is fragmented and biased toward high income hospital settings. To ensure AMR is managed and controlled as a consequence of its contribution to the practice, standardisation of reporting of outcomes, sustainable funding and increased scope of practice frameworks are required.},
keywords = {Antimicrobial Resistance, Antimicrobial Stewardship, Community Pharmacy, Hospital Pharmacy, Pharmacist-Led Interventions, Scoping Review},
month = {March},
doi = {https://doi.org/10.64388/IREV8I9-1719514}
}