Theses (Master Of Pharmacy Practice)

BACKGROUND Antimicrobial resistance (AMR) is a critical global health challenge, necessitating widespread antimicrobial stewardship (AMS) across all healthcare sectors, including community pharmacies. Community pharmacists (CPs) play a key role in AMS by ensuring responsible antimicrobial dispensing, educating patients, and collaborating with prescribers. However, barriers such as limited training, unclear professional roles, and regulatory challenges hinder AMS implementation. This study aims to assess the extent of AMS application among CPs in Malaysia, identify key facilitators and barriers to AMS implementation, and evaluate the perception of AMS among CPs nationwide. Ultimately, our research can help to design a suitable AMS programme for CPs in Malaysia. METHODS A nationwide cross-sectional survey was conducted among 401 registered CPs across Malaysia, selected through convenience sampling. A structured, self-administered questionnaire assessed perceived AMS awareness, antimicrobial dispensing practices, and implementation barriers. The survey was distributed via a Google survey link and disseminated through Whatsapp. Data were analysed and statistical analyses were performed using SPSS (version 28). Descriptive statistics summarised responses, while the Mann–Whitney U and Kruskal–Wallis tests examined associations between demographic factors and AMS-related attitudes, practices, and barriers. Dunn’s post hoc test with Bonferroni correction was pplied for multiple comparisons (p = 0.050). RESULTS Among 401 respondents, 89.0% adhered to prescription regulations, 66.8% consulted national guidelines, and 97.3% educated patients on unnecessary antibiotic use. Collaboration with prescribers was common, with 97.0% encouraging physician consultations. CPs emphasised patient education, with 93.0% raising AMR awareness and 97.8% reinforcing full-course completion. Facilitators included ethical commitment, with 81.0% ensuring valid prescriptions and 89.0% prioritising patient safety over revenue. Barriers included AMS training gaps (28.7%), unclear AMS roles (31.2%), and logistical constraints (29.4%). CPs with 3–10 years of experience were more proactive in AMS, while hospital-trained CPs had greater perceived AMS awareness. CONCLUSION This study underscores the crucial role of CPs in AMS, with strong adherence to AMS principles. However, gaps in training, role clarity, and structured protocols remain. Addressing these barriers through targeted training, clear guidelines, and CP-GP collaboration will enhance AMS application, empowering CPs to combat AMR effectively in community settings. Keywords AMR; Antimicrobial Resistance; AMS; Antimicrobial Stewardship; Community Pharmacists

Introduction: The emergence of multidrug-resistant (MDR) organisms due to inappropriate antimicrobial use has become a global concern, prompting the implementation of Antimicrobial Stewardship Programs (ASP) in healthcare settings. This study aims to evaluate the impact of ASP on antimicrobial utilization, expenditure, and resistance trends, providing insights into the program’s effectiveness. Methods: An Ambi-directional cohort study was conducted to assess pre- and post-ASP antimicrobial utilization, resistance patterns, and cost trends over one year of ASP- implemented in Mahkota Medical Centre (MMC). A Defined Daily Dose (DDD) per 1,000 patient days was used to quantify antimicrobial consumption, and microbiological resistance data were analyzed. Statistical tests, including the Kruskal-Walli’s test and Student’s t-test, were applied to compare pre- and post-ASP outcomes. Additionally, expenditure trends and cost analysis were assessed to determine the financial impact of the ASP. Results: The mean DDD per 1,000 patient days for ASP-targeted antibiotics was significantly decreased by 17% from 161.52 DDD per 1,000 patient days in the pre-ASP period to 134.49 DDD per 1,000 patient days in the post-ASP period mainly from the usage of third generation cephalosporin, carbapenem and colistin. The annual expenditure for ASP-targeted antibiotics had a significant monetary reduction from RM 30,580.50 in the pre-ASP period to RM 20,590.60 during the post-ASP period. Significant reductions in the mean MDR bacterial resistant rate were notable for extended-spectrum beta-lactamase Escherichia coli (E. coli) (27.48%–17.85%), methicillin-resistant Staphylococcus aureus (22.25%–15.73%) and MDR Acinetobacter spp. (71.46%–49.34%). Conclusion: The implementation of ASP leads to a significant reduction in the ASP-targeted antibiotics utilisation, antimicrobial cost, and MDR bacterial resistance rate. These outcomes are beneficial in the justification and expansion of ASP activities in Malaysia. Keywords: Antimicrobial stewardship; Antibiotic use; Defined Daily Dose; Antibiotic cost; Resistance rate.