A Scoping Review of Antimicrobial Stewardship Teaching in Pharmacy Education Curricula

Ziad G. Nasr, PharmD; Duha M. Abbara, PharmD; Kyle J. Wilby, PharmD, PhD


Am J Pharm Educ. 2021;85(6):8415 

In This Article

Abstract and Introduction


Objective: To conduct a scoping review of the existing literature to identify published studies on innovative teaching and assessment practices for antimicrobial stewardship in the Doctor of Pharmacy curriculum and to provide a foundation for future scholarly research in this important area.

Findings: Seven studies were found that met the inclusion criteria. Two of the studies explored the extent, content, and methods of delivery of antimicrobial stewardship, four studies described elective courses in antimicrobial stewardship, and one study described an interprofessional module. Most studies were conducted in the United States. Several pharmacy schools in the UK and the US incorporated antimicrobial stewardship teaching into their curriculum. Learning objectives for the elective courses focused on guidelines issued by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA), antimicrobial stewardship literature appraisal and principal application. The most used teaching strategy was didactic lectures, followed by case studies. Active-learning approaches like simulators, problem-based learning, and presentations were also used but to a lesser extent.

Summary: Antimicrobial stewardship curricular reform may be influenced by the timing of the course, teaching approaches, and performance assessment of students. Antimicrobial stewardship learning should be a required of all pharmacy students. The scarcity of scholarly activity in the teaching of and assessment of learning in antimicrobial stewardship suggests that curricular planning should be guided by national or international organizations to ensure pharmacy students learn such important material.


Antimicrobial resistance leads to infections, resulting in increased morbidities, mortalities, and longer hospital stays, and is therefore a major global public health problem.[1] The Centers for Disease Control and Prevention (CDC) in the United States proposed five core actions to take to combat antimicrobial resistance: infection prevention and control, tracking and data, vaccine and medication development, environment and sanitation, and antibiotic use and access.[2] Antimicrobial stewardship is a coherent set of actions with the intent of promoting appropriate use of antimicrobials.[3] Antimicrobial stewardship is implemented through antimicrobial stewardship programs, where a multidisciplinary team works together to achieve the ultimate goal of optimizing antibiotic use while ensuring proper patient care.[3] Antimicrobial stewardship has been shown to increase cure rates in infectious diseases and decrease treatment failures, adverse effects, antibiotic consumption, antibiotic resistance, and hospital costs.[4–6]

Antimicrobial stewardship teams are multidisciplinary in nature and should include infectious disease physician, an, a clinical pharmacist trained in infectious diseases, a clinical microbiologist, information technology personnel, an infection control professional, and a hospital epidemiologist.[7] Pharmacist expertise is a core element of hospital antimicrobial stewardship programs as per CDC guidelines.[8] In fact, the incorporation of an infectious disease-trained pharmacist within antimicrobial stewardship teams is associated with greater adherence to recommended antimicrobial stewardship practices, decreased inappropriate antimicrobial use, and decreased cost, as well as reduced mortality rates for sepsis and respiratory illnesses.[9–11] The increased attention given to antimicrobial stewardship and the continuous efforts to counter antimicrobial resistance, along with the important role of pharmacists in driving desired outcomes, have resulted in increased demand for pharmacists trained in antimicrobial stewardship.[12]

Training of clinical pharmacists in the management of infectious diseases can be formal, such as through postgraduate residencies, certification programs, or practicing and gaining experience in an infectious disease patient care setting.[13–15] As per the CDC guidelines, in institutions where there is no infectious disease clinical pharmacist, a general clinical pharmacist with infectious disease training can co-lead the antimicrobial stewardship program.[8] In addition, pharmacists can gain exposure to various cases that require effective management of antimicrobial therapy in several settings, not just in infectious disease clinical settings, with varying responsibilities for and opportunities to practice antimicrobial stewardship.[8,16–18] Therefore, new pharmacy graduates might be placed in positions where they need to fulfill certain duties related to antimicrobial stewardship even though they have not completed relevant postgraduate education in this area. It is in such positions where knowledge from a pharmacy curriculum that included antimicrobial stewardship is much needed. Curricular reform has also been suggested by practicing pharmacist stakeholders who see the need to better align antimicrobial stewardship teaching with the rapidly changing demands of real-life pharmacy practice.[13] The American College of Clinical Pharmacy (ACCP) has a pharmacotherapy didactic curriculum toolkit that provides guidance on infectious disease, topics that need to be covered during pharmacy training.[20] Also, the World Health Organization has a published curricula guide for health care education and training on antimicrobial resistance, including pharmacy education.[21] A review conducted by Chahine and colleagues introduced a model to engage pharmacy students in antimicrobial stewardship which included the authors proposed timing for and means of introducing antimicrobial stewardship concepts to pharmacy students, residents, and fellows.[22] Although the review gives insight into how to engage pharmacy students in antimicrobial stewardship, it does not provide information for practical curricular-based interventions.[22]

Given the importance of antimicrobial stewardship and its increased role across multiple practice settings, pharmacy education should be reformed to strengthen students' understanding of antimicrobial stewardship concepts so that they can gain at least minimal competence prior to graduation to prepare them for any pharmacy practice work setting after graduation. The aim of this scoping review was to evaluate the existing literature on the inclusion of antimicrobial stewardship teaching and assessment within professional pharmacy curricula to provide a foundation for future scholarly research and to identify innovative teaching and assessment practices for antimicrobial stewardship programming.