Level of involvement, confidence and perceived barriers to participate in antimicrobial stewardship among Malaysian hospital pharmacists

Hospital pharmacists in Malaysia are expected to participate in antimicrobial stewardship (AMS) activities, yet little is known about the extent of their involvement, confidence and barriers to participate in AMS. This study measured Malaysian hospital pharmacists’ self-reported confidence and participation in AMS and identified barriers limiting their participation. A national cross-sectional survey of hospital pharmacists working in public hospitals was conducted from January to June 2022. A previously validated tool was posted in the WhatsApp group of Malaysian hospital pharmacists with a particular interest in AMS. These pharmacists were also requested to distribute the survey in their professional networks by the study investigators. Out of the 258 pharmacists who responded to the survey, 46.9% ( n = 121) had formal infectious disease (ID) or AMS training. The top three AMS activities reported were adjusting dose of antimicrobials, probing the duration of treatment, and participating in patient care ward rounds. Major barriers limiting pharmacists’ participation in AMS were lack of ID knowledge and confidence to make recommendations. Pharmacists reported highest confidence (> 79%) in pharmacokinetic and pharmacodynamic-based dose optimization. Significant factors associated with greater confidence to participate in AMS were: higher score on the involvement in AMS activities ( p < 0.001), lower score on barriers to participate in AMS ( p < 0.001), higher number of years of AMS experience ( p < 0.001), having a postgraduate qualification ( p = 0.024), working in clinical pharmacy ( p = 0.021), and working at hospitals with specialists ( p = 0.049), in which the first three were the strongest factors. This study identified important barriers limiting Malaysian hospital pharmacists’ confidence and participation in AMS. Addressing such barriers will encourage greater AMS participation by pharmacists.