The Role of the Hospital Pharmacist in Monitoring and Rationalizing the use of Antimicrobials

Abstract

Introduction: Antibiotic resistance poses a major threat to public health, particularly in resource-limited countries where empirical antibiotic therapy and limited access to microbiological testing contribute to inappropriate prescribing. In the Democratic Republic of Congo, data on the role of hospital pharmacists in the rationalization of antibiotic use remain limited.

Methods: A cross-sectional observational study was conducted in several public and private healthcare facilities in Lubumbashi. A total of 903 antibiotic prescriptions were evaluated. Factors associated with inappropriate prescribing were analyzed using multivariate logistic regression. A pharmaceutical intervention score (0–5) was developed to quantify the pharmacist's clinical involvement. The model's performance was assessed using the area under the ROC curve (AUC), the Hosmer– Lemeshow test, and Nagelkerke's pseudo-R².

Results: The rate of inappropriate prescribing was 11.1%. The absence of an antibiogram (ORa = 4.72; 95% CI: 2.95–7.54; p < 0.001) and empirical antibiotic therapy (ORa = 4.61; 95% CI: 2.89–7.34; p < 0.001) were major independent predictors of inappropriate prescribing. Each additional point in the pharmaceutical score reduced the risk by 62% (OR = 0.38; 95% CI: 0.29–0.49; p < 0.001), while a high score (4–5) decreased the risk by approximately 85%. The model demonstrated excellent discrimination (AUC = 0.87) and good calibration (p = 0.55; R² = 0.41).

Conclusion: Structured pharmacist intervention is a powerful and independent determinant of prescription quality, even in contexts of limited diagnostic resources. Its institutional integration represents a key strategic lever for strengthening Antimicrobial Stewardship programs in Lubumbashi.