LAUSR

INTRODUCTION Pharmacists in low-middle-income countries (LMIC) lack in number and antibiotic stewardship (AS) training. We assessed the ability of non-specialised pharmacists to implement stewardship interventions and improve adherence to the South African (SA) community-acquired pneumonia (CAP) guideline in public and private hospitals. METHODS This was a multicentre, prospective cohort study of adult CAP patients hospitalised between July 2017 and July 2018. We developed a CAP bundle of seven process measures (diagnostic and AS) that pharmacists used to audit compliance and provide feedback. CAP bundle compliance rates and change in outcome measures [mortality, length of stay (LOS) and infection-related (IR)-LOS] during pre- and post-implementation periods were compared. RESULTS In total 2464 patients in 39 hospitals were included in the final analysis. Post implementation, overall CAP bundle compliance improved from 47•8% to 53•6% (CI 4•1-7•5, p<0•0001), diagnostic stewardship compliance improved from 49•1% to 54•6% (CI 3•3-7•7, p < 0•0001) and compliance with AS process measures from 45•3% to 51•6% (CI 4•0-8•6, p< 0•0001). Improved compliance with process measures was significant for five (2 diagnostic, 3 AS) of seven components: radiology, laboratory, antibiotic choice, duration and intravenous to oral switch. There was no difference in mortality between the two phases, [4•4%(55/1247) vs 3•9%(47/1217); p=0•54], median LOS or IR LOS 6•0 vs 6•0 days (p=0•20) and 5•0 vs 5•0 days (p=0•40). CONCLUSION Non-specialised pharmacists in public and private hospitals implemented stewardship interventions and improved compliance to SA CAP guidelines. The methodology of upskilling and a shared learning stewardship model may benefit LMIC countries.