Acceptance of Pharmacist-Driven Antimicrobial Stewardship Recommendations With Differing Levels of Physician Involvement in a Children's Hospital

This prospective interventional study assessed whether a pharmacist-physician team in a setting where physician support is not provided for daily antimicrobial stewardship (AS) activities would improve later acceptance of pharmacist recommendations once multidisciplinary efforts stopped and the pharmacist again worked alone. This was measured by AS recommendation acceptance rate during 3 study phases wherein AS recommendations were provided by a pharmacist alone (Phase 1), a pharmacist and a physician together (Phase 2), and then a pharmacist alone again (Phase 3). Recommendations were well accepted across all study phases with no differences in recommendation appropriateness or patient clinical outcomes. Prescribers were significantly (P = .045) more likely to accept recommendations to de-escalate treatment during Phase 3 than during Phase 1. Independently pharmacist-driven AS efforts were generally successful, and recommendations for antimicrobial de-escalation were better accepted after the involvement of an infectious diseases physician.