Impact of pharmacist-led services on antimicrobial stewardship programs: a meta-analysis on clinical outcomes

Abstract

Purpose This meta-analysis aims to find out the impact of pharmacists on clinical outcomes of antimicrobial stewardship (AMS). Method Articles were searched and analyzed based on quality assessed through the JSM quality assessment tool to filter articles with a low level of bias. Two thousand three hundred sixty articles were reviewed for initial screening and 28 articles were included for critical analysis. Statistical analysis used to risk ratio (RR) and standard mean differences calculated using Review manager 5.4. Confidence intervals (CI 95%) were calculated using the fixed-effect model. The I2 statistic assessed heterogeneity. A random-effect model performed in the case of statistical heterogeneity, subgroup and sensitivity analyses. The primary outcome is mortality and inappropriateness, whereas the secondary outcome is cost, readmission, length of stay, consumption and duration of therapy. Result A detailed review and analysis of 28 AMSs programs led by pharmacists showed low inappropriateness with pharmacist versus without pharmacist RR = 0.36 with 95% CI of (0.32 to 0.39) and mortality RR is 0.68 with 95% CI of 0.59 to 0.79. Secondary outcomes such as consumption, length of stay, duration of therapy and cost are standard mean difference of −1.61 with 95% CI (−1.72 to −1.50), −0.58 with 95% CI (−0.62 to −0.53), −0.95 with 95% CI (−1.01 to −0.89) and −0.99 with 95% CI (−1.12 to −0.86), respectively, whereas for 30 days readmission is RR = 0.81 with 95% CI (0.70 to 0.93). Conclusion AMS with pharmacist effectively reduces mortality, inappropriateness, cost, length of stay, duration of treatment, consumption of antimicrobials and the return rate to hospital. So it is suggested pharmacists should lead or play a vital role in antimicrobial stewardship programs to get better outcomes.

A Systematic Review of Pharmacist-Led Antimicrobial Stewardship Programs in Sub-Saharan Africa

“…However, recent studies of both public and private healthcare facilities in SSA have shown that, despite the challenges, with adequate training, pharmacists in SSA can develop and direct AMS programmes similar to their counterparts in the United Kingdom (UK) or the United States of America (USA) [20,21]. Recent reviews have clearly demonstrated the effectiveness of pharmacists leading and playing a central role in stewardship activities by demonstrating a decrease in mortality, length of hospital stay, treatment duration, cost, and antibiotic utilization [22,23].…”

“…Pharmacist-led interventions have been linked to a 10% reduction in mortality in regions such as China and Brazil, according to published literature [59]. In the United Arab Emirates, reviews conducted with the assistance of a pharmacist revealed significant improvements in guideline-concordant antibiotic selection (80.2 percent), duration of therapy (86.2 percent), and dose (86.2 percent) [23]. Furthermore, it has been observed that physicians rely heavily on pharmacists' antibiotic stewardship recommendations and expertise [46].…”

“…Furthermore, it has been observed that physicians rely heavily on pharmacists' antibiotic stewardship recommendations and expertise [46]. According to studies, AMS with a pharmacist resulted in lower antimicrobial consumption than AMS without a pharmacist [23]. Meta-analysis studies conducted in the United Arab Emirates clearly reported lower inappropriateness in antibiotic use with pharmacist involvement (11.88 percent) compared to without (33.7 percent) [23].…”

“…According to studies, AMS with a pharmacist resulted in lower antimicrobial consumption than AMS without a pharmacist [23]. Meta-analysis studies conducted in the United Arab Emirates clearly reported lower inappropriateness in antibiotic use with pharmacist involvement (11.88 percent) compared to without (33.7 percent) [23]. When the number of inappropriately prescribed medicines is reduced, the cost of each individual medicine is reduced [60].…”

“…In China and the Netherlands, pharmacist-led AMS programmes have been linked to savings of up to 80% and more than 25% on antibiotic prophylaxis per procedure, respectively [46]. As seen in a meta-analysis by Mahmood et al [23]and a review by Nathwani et al [61] focusing on North America and Europe, AMS with pharmacist has a positive impact by reducing length of hospital stay by 85 percent, confirming the capability of pharmacist-led AMS to reduce length of hospital stay. ere is mounting evidence from both global and analysed studies that pharmacist-led AMS interventions in SSA result in significantly positive clinical and economic outcomes.…”