Table 2.

Challenges and recommendations for ID pharmacy in KSA.

Challenges/Areas for Improvement	Potential Recommendations
Many ASPs are managed by physicians and not all hospitals have systems to involve ID pharmacists in ASP activities. In other institutions, ASP are managed by ID pharmacists only and physicians are not involved.	Increase the number of ID pharmacists and physicians trained on ASP and facilitate their collaboration for best clinical outcomes.
The ASP systems in most hospitals are paper-based system and lack automation and clinical decision support.	Invest in ASP electronic health records platform.
ASP in some hospitals is conducted by pharmacists are not specialized ID (i.e., did not complete ID pharmacy residency). The background of such pharmacists may vary, and they may not have solid understanding of and clinical experience in microbiology, ID, and pharmacology of antimicrobial drugs.	Increase the number of ID trained pharmacists and the number of residency program seats in KSA.
Some hospitals in KSA do not have a structure and job description for the ID/ASP pharmacist.	Develop ID/ASP pharmacist work structure and job description.
Not all hospitals have ID physicians, which may limit ID pharmacists to function in full capacity.	Increase the number of physicians trained in ID.
Not all hospitals have antimicrobial committee.	Encourage hospitals to establish antimicrobial committee.
Requirements for clinical pharmacy faculty members vary between the universities in KSA with some universities approve local residency training while others only allow the completion of such training in the US. It is important that such universities be aware that the opportunities in the US are competitive and limited, which may end up with the candidate having to obtain a Doctor of Philosophy degree in a non-clinical specialty.	Increase awareness about tracks for clinical pharmacy education for policymakers in KSA and encourage more efforts to facilitate Saudi scholars to obtain residency training.
Lack of ID pharmacy fellowship in KSA.	Encourage university and hospitals in KSA to establish ID pharmacy fellowships.
In some Saudi universities, ID clinical pharmacists are separated from clinical practice to focus on academic tasks like teaching, research, and administration.	Encourage more integration between practice and academic sites via discussion with policymakers.
Some ID pharmacy residency training sites do not expose the resident to all the elements of ASP.	Encourage the implementation of all ASP elements as in IDSA and CDC ASP guidelines, as well as ID pharmacy residency structure in ASHP residency manual.
Some hospitals hire PharmD graduates without obtaining residency training to work as ID clinical pharmacists.	Encourage more trained pharmacists specializing in ID to establish programs and have the correct route to practice as an ID pharmacist.
Many pharmacists indicated they can work easily with ID physicians in the US and Canada. This might be because those physicians were used to work with ID pharmacists there.	Increase awareness of appropriate ASP and ID practice structures adopted from the North American system.
There is a gap for ID pharmacists to conduct PK/PD research due to lack of specialized laboratories.	Encourage the systems and policymakers to establish PK/PD laboratories for ID pharmacists and pharmacologists to have more research activities and secure funding from Saudi research agencies.
Some institutions hire only one ID pharmacist to cover the clinical service, education and training, and scholarly activities which could lead to burnout and suboptimal coverage.	Encourage institutions to hire more than one ID pharmacist to cover the all the services and tasks to ensure optimal coverage.
Non-major cities lack specialized ID trained pharmacists or have very limited number.	More efforts are needed to increase the number of ID specialized pharmacists in non-major cities.
The number of cost-effectiveness studies on the ASP is limited.	Encourage researchers and healthcare agencies to conduct more cost-effectiveness studies to highlight the positive financial impact of implementing ASP programs.
The number of ID research projects related to ASP is limited especially in outpatient settings.	Increase ID pharmacists’ involvement in ASP research projects in variety of settings including inpatient and outpatient.
Pharmacy students undergoing ID APPE may not be trained by an ID clinical pharmacist.	Encourage pharmacy colleges and hospitals in KSA to train pharmacy students completing ID APPE by an ID clinical pharmacist.
ID pharmacists’ involvement in research projects and publications is limited outside the academic fields.	Encourage ID pharmacists to publish more research projects related to ID pharmacotherapy and projects evaluating the value and the roles of ID pharmacists in various settings.
There is a low involvement of ID pharmacists in the development of clinical practice guidelines in KSA.	Encourage ID pharmacists’ participation in the development of clinical practice guidelines given their pharmacy expertise.
There is a limited participation of ID pharmacists in white papers, position papers, and clinical consensus statements.	Encourage ID pharmacists to be more active in publishing white papers, position papers, and clinical consensus statements.

ASHP, American Society of Health-system Pharmacists; ASP, antimicrobial stewardship program; CDC, Centers for Disease Control and Prevention; ID, infectious diseases; IDSA, Infectious Diseases Society of America; OPAT, outpatient parenteral antimicrobial therapy; PGY2, postgraduate year 2; PharmD, Doctor of Pharmacy; PK/PD, pharmacokinetic/pharmacodynamic; KSA, Kingdom of Saudi Arabia; US, United States.