Two decades of clinical pharmacists: top 10 roles in the 20 years: What every pharmacist and antimicrobial stewardship should know

Objective: To examine the evolution of clinical pharmacists' roles in antimicrobial stewardship (AMS) over the last twenty years, focusing on the implementation of AMS strategies and measures, with an emphasis on the significant changes during the COVID-19 pandemic and their impact on antimicrobial resistance (AMR). Methods: This scoping review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, evaluated the engagement of pharmacists in AMS from 2000 to 2021. It involved a detailed database search across MEDLINE, CINAHL, and Google Scholar, among others, to select pertinent peer-reviewed articles, with the Mixed Methods Appraisal Tool (MMAT) 2018 version employed for assessing their quality. Results: From an initial pool of 8,763 abstracts, six articles were ultimately included for analysis. Key findings highlight pharmacists' roles in AMS, encompassing formulary restrictions, antibiotic reviews, and leveraging technology. Pharmacists have evolved from dispensers to AMS leaders, crucial during the COVID-19 pandemic in mitigating AMR risks. Their involvement in multidisciplinary teams and conducting prospective audits with feedback was notable. The pandemic highlighted their adaptability through virtual interventions, monitoring, and the use of quality indicators. Conclusions: In the past two decades, clinical pharmacists have been instrumental in advancing AMS, evolving from dispensers to leaders in AMS initiatives vital for addressing AMR, a prominence highlighted during the COVID-19 crisis. This review emphasizes the need for ongoing collaboration and support to strengthen AMS and manage AMR.