87 Copyright © All rights are reserved by Abdul Kader Mohiuddin. Lupine Online Journal of Pharmacology & Clinical Research Short Communication Pharmacist-Led Antimicrobial Stewardship Abdul Kader Mohiuddin* Department of Pharmacy, World University of Bangladesh, Bangladesh *Corresponding author: Abdul Kader Mohiuddin, Department of Pharmacy, World University of Bangladesh, Dhanmondi, Bangladesh Received: July 04, 2019 Published: July 08, 2019 Short Communication The value of critical care pharmacists has been well documented. Various studies have shown that critical care pharmacists reduce medication errors, improve patient outcomes, reduce costs and waste, and decrease mortality rates among patients with thromboembolic diseases or infections [1,2]. Antimicrobial resistance (AMR) causes prolonged illness, greater risk of infection spread, increased morbidity, and higher mortality rates, which result in increased expenses to the government, healthcare services, and individuals. It is estimated that around 700,000 people die annually from drug-resistant infections, with experts predicting an alarming possible increase to 10 million deaths each year by 2050 and major future challenges to the way we practice medicine and surgery. Resistance has been associated with increasing mortality, treatment failure and healthcare costs [3,4]. This alarming rate exceeds the annual number of deaths caused by cancer (8.2 million) and is almost ten times that of motor vehicle accidents (1.2 million) [5]. In the United States, in addition to significant mortality, antimicrobial resistance adds $20 billion in excess direct health care costs and up to $35 billion in annual societal costs as a result of lost productivity [6]. Antibiotic stewardship was established to combat this trend and was recognized in 1996 to draw attention to the rising incidents in mortality and morbidity associated with inappropriate use of antibiotics [7]. Antibiotic stewardship is a core part of critical care, and many times, the physician will rely on the pharmacist’s recommendations and expertise. Antibiotic Stewardship Recommendations include constituting a team, close coordination between teams, audit, formulary restriction, de- escalation, optimizing dosing, active use of information technology among other measure [8]. The Infectious Diseases Society of America guidelines on antimicrobial stewardship recommend that the core multidisciplinary stewardship team include an infectious diseases (ID) physician and a clinical pharmacist with ID training [9]. Antibiotic prescribing in outpatient settings exceeds that of inpatient prescribing, with more than 150 million antibiotic prescriptions annually; of these prescriptions, more than 30% are either unnecessary or inappropriately prescribed [10-12]. Orally administered antimicrobials accounted for approximately 90% of total consumption: oral third generation cephalosporins, macrolides, and fluoroquinolones accounted for approximately 77% of oral consumption. Therefore, pharmacists must extend their support for the appropriate use of antimicrobials prescribed by attending physicians to not only hospitalized patients but also outpatients [13]. As the regulations for antibiotic stewardship in outpatient settings continue to evolve and optimal stewardship strategies are defined, pharmacists must be leaders in the implementation of these programs [14]. Stewardship programs can help, reduce inappropriate prescription and broad-spectrum use of antimicrobials, improve, clinical outcomes for the population as a whole, slow down the emergence of antimicrobial resistance and conserve healthcare resources [3]. The WHO Global Action Plan on Antimicrobial Resistance recommends countries work together to improve awareness and understanding of antimicrobial resistance, including through social media. The 2018 World Antibiotic Awareness Week campaign used Twitter to tailor media messages about the Global Action Plan [15]. Social media have become important information channels but may not reach people with low knowledge and/or low interest in the subject. Within the EU, countries with low use of antibiotics, such as Sweden and The Netherlands, show a higher population knowledge level [16]. The use of community antibiotic stewardship programs (ASPs) is rising. ASPs involving pharmacists are effective in decreasing antibiotic prescribing and increasing guideline- adherent antibiotic prescribing by GPs [17]. Evidence in China and Netherlands showed that antibiotic stewardship program was associated with more less 80% and more than 25% decrease in cost of antibiotic prophylaxis per procedure respectively [18]. The issue of antimicrobial resistance is worse in low and middle- income countries (LMIC), as the incidence of infectious diseases is high compared to high-income countries. In low and middle- income countries, the mortality rates due to antimicrobial- resistant bacteria are under-reported, however, available data in India, Nigeria, Pakistan, and Congo indicate that a huge number ISSN: 2644-1373 DOI: 10.32474/LOJPCR.2019.01.000117