Pharmacist-driven antimicrobial stewardship: evolving roles in clinical practice

Antimicrobial resistance (AMR) poses a major global public health threat. The effective implementation of antimicrobial stewardship (AS) is essential for optimizing antimicrobial use and improving clinical outcomes. In this context, pharmacists play a central role by managing pharmacotherapy across multiple clinical practice domains. This narrative review summarizes evidence on pharmacist-driven AS, focusing on three key areas: (i) the facilitation of proper antimicrobial use, (ii) the management of antimicrobial-related adverse events, and (iii) support for evidence-based infection control and prevention. Prospective audit and feedback, surveillance of antimicrobial consumption and outcomes, diagnostic stewardship, and educational interventions represent the core strategies through which pharmacists optimize antimicrobial use. Additionally, pharmacists can enhance treatment safety by conducting structured risk assessments and monitoring drug-specific toxicities. Pharmacists further support infection control practices through disinfectant management, outbreak response, and post-exposure prophylaxis. Finally, the integration of real-world data and structured workforce development programs is essential for sustaining and advancing pharmacist-driven AS. This review highlights the role of pharmacists as leaders in the implementation and continuous refinement of AS tailored to institutional and regional healthcare needs.