. 2022 Nov 7;2(1):e176. doi: 10.1017/ash.2022.310

Table 1.

Summary of studies on ASP with clinical pharmacist involvement in Asia classified by countries

Country	Type of study and population	Intervention	Primary outcomes	Secondary outcomes
Japan
Uda A, et al. 2022²¹	Study design: Pre and post intervention Study period: 2017-2019 Setting: Tertiary-care hospital Participants: N/A	ID Pharmacist perform a daily structured review of antibiotic prescriptions, Educating prescribers on antimicrobial therapy, Monthly reporting of department-level rates of blood sampling for culture Comparator: baseline period (May-Dec 2017) vs Intervention period (May-Dec 2018) and post-intervention period (May-Dec 2019	- Increased rate of appropriate blood culture collections and de-escalation therapy (71% vs 85%, P < .001)	- Decrease in antipseudomonal agent and carbapenem consumption (P = .016 and P = .004) - Decrease incidence of HA-CDI (P = .031) - Decrease 30-day mortality (P = .005) - Similar length of stay
Fukuda T, et al. 2021²²	Study design: Retrospective cohort Study period: 2013-2015 Setting: uncomplicated gram-negative bacteremia patient, community hospital Participants: 66	Pharmacists perform an antimicrobial time-out at 72 hours after blood culture collection, optimized treatment based on the patient’s clinical response and test results Comparator: no pharmacist and no ID physician	- Decrease duration of antimicrobial treatment (8 vs 14 days, P < .001)	- Higher trend of de-escalation rate (P = .08) - Similar clinical success and failure, recurrence, infectious diseases re-admission, Clostridioides difficile infection, and 30- and 60-day mortality rates
Nakamura S, et al. 2021²³	Study design: Retrospective study Study period: 2018-2019 Setting: Community hospital Participants: 535	Pharmacists perform daily follow up, ASP team weekly round Comparator: preintervention period	- Increase in rate of orders for blood culture (56.3% vs 73.3%, P < .01) - Increased rate of de-escalation (10.2% vs 30.8%, P < .05) - Decrease in piperacillin/tazobactam and carbapenems consumption (P < .01)	- No different in 30-day mortality - Decrease 30-day recurrence rate (14.7% vs 7.5%, P < .05) - Acceptance rate of pharmacist’s intervention 94.1%
Ohashi K, et al. 2018²⁴	Study design: Historical-control trial Study period: N/A Setting: MRSA bacteremia patient, Municipal hospital Participants: 94	Pharmacists received an alert of blood cultures positive for MRSA and immediate intervention according to the bundle Comparator: preintervention period	- Increase in compliance rate with the appropriate duration of therapy (44.8% vs 72.1%, P = .027), early use of anti-MRSA drugs (62.3% vs 82.4%, P = .038), higher rate of negative follow-up blood cultures (40% vs 80%, P < .001)	- Decrease in 30-day mortality (41.8% vs 21.6%, P = .044) - Decrease in hospital mortality (58.1% vs 27.5%, P = .003)
Hasegawa S, et al. 2021²⁵	Study design: Pre and post intervention, crossover trial Study period: 2018-2019 Setting: inpatient tertiary care hospital Participants: 587 patients prescribed IV vancomycin	Time-out intervention between clinical pharmacist-led time-out arm and an ID physician-led time-out arm Comparator: pre-prescription authorization	- Decrease in weekly vancomycin DOT per 1000 patient-day in phase 2 (coefficient −0.49, P = .007) - Decrease in antimicrobial usage in the pharmacist-led arm (coefficient −0.77, P = .007)	- Higher proportion of vancomycin discontinuations within 72 hours in phase 2 - Similar mean vancomycin use, median length of stay, and in-hospital mortality
Takito S, et al. 2020²⁶	Study design: pre and post intervention Study period: 2013-2017 Setting: Skilled nursing facility Participants: N/A	Pharmacists provided prescription recommendations to physicians based on Gram stain results Comparator: preintervention period	- Reduction in the slope of total number of all antimicrobials prescriptions per 100 residents per month (IRR 0.885, P < .001)	- Decrease in number of prescriptions for macrolides and fluoroquinolones per 100 residents per month (P = .154 and .753) - Similar number of prescriptions for cephalosporins per 100 residents per month
Thailand
Apisarnthanarak A, et al. 2015⁵	Study design: Quasi-experimental, prospective, concurrent groups Study period: Jan 2012-Sep 2012 Setting: Medicine ward, tertiary-care hospital Participants: 574	Pharmacists perform PPAF Comparator: standard of care	- Less likely to use antibiotic inappropriately (P < .001)	- More antibiotic de-escalation (P < .001) - less duration of antibiotic use < 7 days (P < .001) - Shorter hospital length of stay (P < .001) - No difference in mortality
Rattanaumpawan P, et al. 2018⁶	Study design: Randomized controlled trial Study period: Feb – Sep 2013 Setting: Medicine ward, tertiary-care hospital Participants: 1632	Pharmacists perform PPAF Comparator: ID clinicals fellow perform PPAF	- Non-inferiority in clinical response rate (44.9% vs 39.7%, P = .20, difference 5.15%, 95% CI 2.69 – 12.98%)	- Similar in microbiological outcomes, antibiotic-associated complications, antibiotic consumption, antibiotic expenditure, and length of stay
Jantarathaneewat K, et al. 2021²⁷	Study design: Quasi-experimental, prospective, concurrent groups Study period: Aug 2019 – April 2020 Setting: Febrile neutropenic patient, tertiary-care hospital Participants: 90	Pharmacist performed daily PPAF and education Comparator: standard ASP	- Increase appropriateness of prescription (88.9% vs 51.1%, P < .001)	- Trend to lower meropenem, ceftazidime and cefepime similar 30-day ID mortality and length of stay - Acceptance rate of pharmacist’s recommendation 93.8%
Jantarathaneewat K, et al. 2022¹³	Study design: Quasi-experimental, prospective, concurrent groups Study period: 2019-2020 Setting: Medicine ward, tertiary-care hospital Participants: 400	ID pharmacist Daily prospective audit and feedback Comparator: standard ASP group	- Guideline adherence was higher in intervention group (79% vs 56.6%, P < .001)	- Trend to decrease 30-day all-cause mortality (15.9% vs 1.5%, P = .344) - Trend towards improved Clinical cure rate (63.6% vs 56.1%, P = .127) - Decrease Carbapenems consumption (P =.042) - Decrease Incidence of multidrug resistant pathogens (P = .049) - Similar Length of stay (P = .085)
China
Li Z, et al. 2017³⁰	Study design: Prospective cohort study Study period: March – April 2014 Setting: Intensive care units, multicenter Participants: 577	Pharmacists in 4 ICUs perform daily ward round and communicate with physician when inappropriate are prescribed Control: other 4 ICUs without pharmacists’ involvement	- Lower all-cause hospital mortality (19.3% vs 29.0%; P = .007)	- Reduce multidrug resistance (31.7% vs 23.8%, P = .037) - Less inappropriate third- and fourth-generation cephalosporin initiation (9.1% vs 15.2%, P = .031) - Shorter duration of mechanical ventilation (P = .184), length of stay in ICU (P = .227), and length of stay in hospital (P = .544) - Acceptance rate of pharmacist’s recommendation 71.9%
Du Y, et al. 2020³¹	Study design: Retrospective study Study period: 2016-2018 Setting: Gastroenterology ward, tertiary-care hospital Participants: 1763	Pharmacists perform daily ward rounds with physicians, regular review of medical orders, monthly indicator feedback, frequent physician training, and necessary patient education Comparator: pre intervention period	- Decrease in intensity of antibiotic consumption (coefficient −0.88, P = .01)	- Decrease in proportion of patients receiving combined antibiotics (coefficient −9.91, P = .03) - Decrease in average length of hospital stay (coefficient −1.79, P = .00) - Temporary increase in patients receiving antibiotics (coefficient 4.95, P = .038)
Zhou Y, et al. 2015³²	Study design: prospective study with historical controls Study period: 2010-2013 Setting: Department of urology, tertiary-care hospital Participants: 234	Pharmacists led the antibiotic stewardship program at the hospital and on the urological clinical service; performed prospective audits and feedback from 2011 to 2013 Comparator: no pharmacist involvement period (2010)	- Decrease in antibiotic use density by 58.8% - Average antibiotic cost decreased by US $246.94	N/A
Xu J, et al. 2022³³	Study design: Quasi-experimental, concurrent groups, retrospective Study period: 2018-2019 Setting: Department of Vascular and interventional radiology, Tertiary hospital Participants: 1026	Pharmacists perform Daily PPAF and guideline development Comparator: ASP team without pharmacist group	- Average score of inappropriate antimicrobials decreases in intervention group: perioperative antimicrobial prophylaxis (coefficient −0.207, P < .001), Non-surgical antimicrobial prophylaxis (coefficient −0.164, P = .010), Therapeutic use of antibiotics (coefficient −0.0694, P = .003)	- Decreased antimicrobial consumption (P = .017) - Decreased antimicrobial cost (P = .006) - Decreased average cost per defined daily dose (P < .001) - Similar total cost of hospitalization (P = .476) and length of hospital stay (P = .375) - Acceptance rate of pharmacist’s recommendation 52.78% for non-surgical prophylaxis, 76.69% for surgical prophylaxis, 86.18% for treatment
Zhou H, et al. 2021³⁴	Study design: pre-and postintervention study Study period: June 2018- March 2019 Setting: Orthopedics department in a tertiary-care hospital Participants: 873	Pharmacist-led ASP team participated in ward rounds, reconciled patient’s allergy history, education, and performed standard intradermal skin test with the perioperative antibiotic prophylaxis regimen Comparator: pre-intervention period	- Decrease in the utilization of intradermal skin tests, from 95.8% to 16.5% (P < .001) - More cephalosporins used as prophylactic antimicrobial (P < .001) - Reduced antimicrobial expenditure by US $150.21 (P < .001) for each patient	- postintervention population was less likely to undergo an intradermal skin test (OR: 0.008, 95% CI: 0.005–0.014) - Patients in postintervention group had a 5.3-fold higher likelihood (95% CI: 2.95–9.43) of having cephalosporin as prophylactic antimicrobials
Wang H, et al. 2019³⁵	Study design: Retrospective study Study period: July 2010- Dec 2016 Setting: Tertiary-care hospital Participants: patients with outpatient prescription (17,766,637) and inpatient prescriptions (376,627)	ASP interventions led by pharmacists such as formulating the activity program and performance management, advising on antibacterial prescriptions and training Comparator: baseline period	- Decreased in the number of antibiotic prescriptions in the inpatient setting by 59% (P < .05) and the outpatient setting by 33% (P < .05) each month - Decreased number of of antibiotic prophylaxis by 5.71% (P < .001) each month - Decrease DDD from 102.46 to 37.38 DDD/100 bed-days (P < .05) - Significant decrease in resistance rates among E. coli and P. aeruginosa isolates to fluoroquinolones - Significant decrease in the incidence of MRSA - Significant increase in resistance rates of E. coli and K. pneumoniae to carbapenems	- Increase rational timing of initial dose and rational duration
Zhang J, et al. 2020³⁶	Study design: prospective, multicenter cohort study Study period: April 2017- Dec 2019 Setting: 17 acute care hospitals across Guizhou Province Participants: 2663 with confirmed infections	Pharmacist conducted a chart review and provided recommendation to clinician	- More effective clinical response was observed in patients whose provider accepted the ASP recommendation intervention group (81.34% vs 67.16%, P < .001)	- non-ID pharmacist showed similar effective clinical response to ID pharmacist (P = .896) - Acceptance rate of pharmacists ‘recommendation was 5.0%
Xu S, et al. 2021³⁷	Study design: retrospective, observational pre-and post-intervention study Study period: 2018-2020 Setting: tertiary-care hospital Participants: 524 patients with community-acquired pneumonia eligible for IV to PO conversion	Prescribers were contacted by pharmacists about patients who were eligible for IV to oral antibiotic switches through computer- generated messages (phase 2) Comparator: prescribers were contacted bypharmacists who verbally informed them of patients who were eligible for an IV to oral conversions (phase 1)	- Increased proportion of patients who were converted to oral therapy on the day they were eligible from 34.8% in phase 1 to 62.7% in phase 2 (P < .05)	- Shorter lengths of IV antibiotic therapy days and hospital stay (P < .05) - Similar total length of antibiotic therapy day (P > .05)
Korea
Song JY, et al. 2015³⁸	Study design: pre and post intervention Study period: 2013 Setting: patient who received double anti-aerobic activity, Tertiary-care hospital Participants: 313	Pharmacists perform education and PPAF along with ID physician Comparator: preintervention period	- Decrease number of patients receiving unnecessary double anti-aerobic activity more than 3 days (26.8 vs 7, P = .005) - Decrease proportion of patients receiving unnecessary double anti-aerobic activity more than 3 days (42.3% vs 13.6%, P < .001)	- Acceptance rate of pharmacist’s recommendation 93.9%
Suh Y, et al. 2021³⁹	Study design: retrospective study Study period: Jan-March 2017 Setting: multicenter, Tertiary hospital Participants: 4995	ASP with pharmacist involvement who intervene in antimicrobial prescription, perform TDM and monitored antimicrobial-related adverse drug event Comparator: ASP without pharmacist involvement	- Less incidence proportion of antimicrobial-related adverse event (8.9% vs 14.7%, P < .001)	- multidisciplinary ASPs including clinical pharmacists reduced the risk of antimicrobial-related ADEs by 38% (adjusted odds ratio 0.62; 95% CI 0.50–0.77)
India
Nampoothiri V, et al. 2021⁴⁰	Study design: Descriptive study Study period: 2016-2017 Setting: Tertiary care hospital Participants: 1326	Pharmacists perform daily PPAF Comparator: baseline period	- Increase appropriateness to 80% in the third year of intervention period - Decrease in antimicrobial consumption	- Decrease in antimicrobial consumption - Acceptance rate of pharmacist’s recommendation 70%

DDD, defined daily dose; HA-CDI, hospital-acquired Clostridioides difficile infection; ID, infectious diseases; IRR, incidence rate ratios; IV-PO conversion, intravenous to oral antibiotic conversion ; MRSA, Methicillin-resistant Staphylococcus aureus; TDM, therapeutic drug monitoring; PPAF, prospective audits and feedback.