What do future pharmacists know about, and think of, antimicrobial stewardship?



Antimicrobial Stewardship, Attitudes, Knowledge, Pharmacy, Undergraduate Student


Introduction: This work aimed to investigate future pharmacists’ knowledge of, and attitudes towards, antimicrobial stewardship, a subject area which is embedded in the Queen's University Belfast (QUB) pharmacy undergraduate curriculum.

Methods: Following ethical approval and piloting, QUB final year pharmcy students (n=118) were invited to complete a questionnaire on antimicrobial stewardship with questions relating to knowledge of, and opinions on, the concept including whether antimicrobials are advocated for various clinical conditions. Data analysis involved descriptive statistics (% and frequencies) with statistical tests, including the Mann-Whitney U test and t-test employed for sub- analysis (of responses and mean scores for male versus female students and United Kingdom & Ireland versus international students), with significance set at p<0.05.

Results: The response rate was 94.9% (112/118). While no differences of note were evident for gender, United Kingdom & Ireland students were significantly more likely (p<0.001) to be knowledgeable and have appropriate attitudes than international students. Their mean overall score was 73.56 (±5.41) versus 68.27 (±6.06) for knowledge (maximum score was 91) and 38.07 (±4.69) versus 32.94 (±5.04) for attitudes (maximum score was 45). Only 61.6% (69/112) of respondents felt confident discussing antimicrobial stewardship with patients or other healthcare professionals.

Discussion: While reasonable scores were obtained, further research is needed to ascertain why one in three future pharmacists did not feel confident discussing antimicrobial stewardship. Despite coverage of this subject area throughout the degree programme, it seems that more educational interventions are required (particularly for international students) to ensure graduates can meaningfully contribute to this global health priority in practice.

Author Biographies

Lezley-Anne Hanna, Queen's University Belfast

Professor (Education) - School of Pharmacy

Carrie McMichael, Queen's University Belfast

MPharm Graduate - School of Pharmacy

Maurice Hall, Queen's University Belfast

Senior Lecturer - School of Pharmacy


Abbo, L.M., (2013). Medical students’ perceptions and knowledge about antimicrobial stewardship: how are we educating our future prescribers? Clinical Infectious Diseases, 57(5), 631-638

ACPE [Accreditation Council for Pharmacy Education]. (2016). Standards and Key Elements Accreditation standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree, Section I: Educational Outcomes (online). Available at: https://www.acpe-accredit.org/ pdf/Standards2016FINAL.pdf. Accessed 6th July, 2018

Ahmad, A., Khan, M.U., Moorthy, J., Jamshed, S.Q. & Patel, I. (2015). Comparison of knowledge and attitudes about antibiotics and resistance, and antibiotics self- practicing between Bachelor of Pharmacy and Doctor of Pharmacy students in Southern India. Pharmacy Practice,13(1), 523

Australian Government, Department of Health, Department of Agriculture. (2015). Responding to the Threat of Antimicrobial Resistance. Australia's First National Antimicrobial Resistance (AMR) Strategy 2015-2019 (online). Available at: https://www.amr. gov.au/australias-response/national-amr-strategy Accessed 16th April, 2019

Avent, M.L., Fejzic, J. & van Driel, M.L. (2018). An underutilised resource for Antimicrobial Stewardship: a 'snapshot' of the community pharmacists' role in delayed or 'wait and see' antibiotic prescribing. International Journal of Pharmacy Practice, 26(4), 373-375

Burger, M., Fourie, J., Loots, D., Mnisi, T., Schellack, N., Bezuidenhout, S. & Meyer, J.C. (2016). Knowledge and perceptions of antimicrobial stewardship concepts among final year pharmacy students in pharmacy schools across South Africa. Southern African Journal of Infectious Diseases, 31(3), 84-90

Castro-Sánchez, E., Drumright, L.N., Gharbi, M., Farrell, S. & Holmes, A.H. (2016). Mapping antimicrobial stewardship in undergraduate medical, dental, pharmacy, nursing and veterinary education in the United Kingdom. PLoS One, 11(2), e0150056

CDC [Centers for Disease Control and Prevention]. (2010). Increasing Questionnaire Response Rates (online). Available at: https://www.cdc.gov/ healthyyouth/evaluation/pdf/brief21.pdf Accessed 7th July, 2018

CDC [Centers for Disease Control and Prevention]. (2018). Antibiotic resistance (AR) solutions initiative (online). Available at: https://www.cdc.gov/drug resistance/solutions-initiative/antibiotic- stewardship.html Accessed 6th July, 2018

Davis, H., Mant, D., Scott, C., Lasserson, D. & Rose, P.W. (2009). Relative impact of clinical evidence and over-the-counter prescribing on topical antibiotic use for acute infective conjunctivitis. British Journal of General Practice, 59(569), 897-900

Davis, L.C., Covey, R.B., Weston, J.S., Hu, B.B. & Laine, G.A. (2016). Pharmacist-driven antimicrobial optimization in the emergency department. American Journal of Health-System Pharmacy, 73 (Sup.l1),S49-56

Dyar, O.J., Pulcini, C., Howard, P. & Nathwani, D. (2014). European medical students: a first multicentre study of knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance. Journal of Antimicrobial Chemotherapy, 69(3), 842-846

Gallagher, J.C., Justo, J.A., Chahine, E.B., Bookstaver, P.B., Scheetz, M., Suda, K.J., Fehrenbacher, L., Klinker, K.P. & MacDougall, C. (2017). Preventing the post- antibiotic era: training future pharmacists as antimicrobial stewards. American Journal of Pharmaceutical Education, https://www.ajpe.org/doi/ pdf/10.5688/ajpe6770

General Pharmaceutical Council. (2011). Future pharmacists: Standards for the initial education and training of pharmacists (online). Available at: https:// www.pharmacyregulation.org/sites/default/files/ document/gphc_future_pharmacists_may_2011.pdf Accessed 9th July, 2018.

Gilchrist, M., Ashiru-Oredope, D., Howard, P., Sneddon, J., Whitney, L. & Wickens, H. (2015). Antimicrobial stewardship from policy to practice: experiences from UK antimicrobial pharmacists. Infectious Diseases and Therapy, 4(1), 51-64

GOV.UK. (2018). Antimicrobial Resistance (AMR) information and resources on the government’s plans to slow the growth of antimicrobial resistance (online). Available at: https://www.gov.uk/government/ collections/antimicrobial-resistance-amr-information- and-resources Accessed 5th July, 2018

Hall, M., Hanna, L-A. & Kong, I.H. (2017). English language ability and academic performance of international pharmacy students. 8th All Ireland Pharmacy Conference, Dundalk, Ireland (online). Available at: https://iiop.ie/sites/default/files/AIPC% 20Proceedings%202017.pdf. Accessed 5th July, 2018.

Hwang, A.Y. & Gums, J.G. (2016). The emergence and evolution of antimicrobial resistance: Impact on a global scale. Bioorganic & Medicinal Chemistry, 24(24), 6440-6445

Inácio, J., Barnes, L.M., Jeffs, S., Castanheira, P., Wiseman, M., Inácio, S., Bowler, L. & Lansley, A. (2017). Master of Pharmacy students’ knowledge and awareness of antibiotic use, resistance and stewardship. Currents in Pharmacy Teaching and Learning, 9(4), 551-559

Justo, J.A., Gauthier, T.P., Scheetz, M.H., Chahine, E.B., Bookstaver, P.B., Gallagher, J.C., Hermsen, E.D., DePestel, D.D., Ernst, E.J., Jacobs, D.M., Esterly, J.S., Suda, K.J., Olsen, K.M., Abbo, L.M. & MacDougall, C..(2014). Knowledge and attitudes of doctor of pharmacy students regarding the appropriate use of antimicrobials. Clinical Infectious Diseases, 59 (Suppl 3), S162-169

Khachatourians, G.G. (1998). Agricultural use of antibiotics and the evolution and transfer of antibiotic- resistant bacteria. Canadian Medical Association Journal, 159(9), 1129–1136

Kufel, W.D., Jeffres, M.N., MacDougall, C., Cho, J.C., Marx, A.H. & Williams, D.M. (2018). Antimicrobial stewardship education in US colleges and schools of pharmacy. Journal of Antimicrobial Chemotherapy, 73(8), 2252–2258. doi.org: 10.1093/jac/dky166

Minen, M.T., Duquaine, D., Marx, M.A. & Weiss, D. (2010). A survey of knowledge, attitudes, and beliefs of medical students concerning antimicrobial use and resistance. Microbial Drug Resistance, 16(4), 285-289

NICE [National Institute for Health and Care Excellence]. (2015). Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use NICE guideline [NG15] (online). Available at: https://www.nice.org.uk/guidance/ng15/ chapter/1-Recommendations Accessed 6th July, 2018.

NICE [National Institute for Health and Care Excellence]. (2017). Antimicrobial stewardship: changing risk related behaviours in the general population NICE guideline [NG63] (online). Available at: https://www.nice.org.uk/guidance/ng63 Accessed 6th July, 2018.

NICE [National Institute for Health and Care Excellence]. (2018). Antimicrobial stewardship: prescribing antibiotics [KTT9] Key Therapeutic Topic 9 (online). Available at: https://www.nice.org.uk/advice/ ktt9/chapter/evidence-context Accessed 6th July, 2018

NICE CKS [National Institute for Health and Care Excellence Clinical Knowledge Summaries]. (2018). Available at: https://cks.nice.org.uk Accessed 7th July, 2018

Pulcini, C., Wencker, F., Frimodt-Møller, N., Kern, W.V., Nathwani, D., Rodríguez-Baño, J., Simonsen, G.S., Vlahović-Palčevski, V., Gyssens, I.C. (2015). European survey on principles of prudent antibiotic prescribing teaching in undergraduate students. Clinical Microbiology and Infection, 21(4), 354-361

Rajiah, K., Ren, W.S. & Jamshed, S.Q. (2015). Evaluation of the understanding of antibiotic resistance among Malaysian pharmacy students at public universities: an exploratory study. Journal of Infection and Public Health, 8(3), 266-273

Rusic. D., Bozic, J., Vilovic, M., Bukic, J., Zivkovic, P.M., Leskur, D., Perisin, A.S., Tomic, S. & Modun, D. (2018). Attitudes and Knowledge Regarding Antimicrobial Use and Resistance Among Pharmacy and Medical Students at the University of Split, Croatia. Microbial Drug Resistance, doi.org:10.1089/mdr. 2018.0010

Scaioli, G., Gualano, M.R., Gili, R., Masucci, S., Bert, F. & Siliquini, R. (2015). Antibiotic use: a cross- sectional survey assessing the knowledge, attitudes and Practices amongst Students of a School of Medicine in Italy. PLoS One, 10(4), e0122476

Wasserman, S., Potgieter, S., Shoul, E., Constant, D., Stewart, A., Mendelson, M. & Boyles, T.H. (2017). African medical students’ perceptions and knowledge about antibiotic resistance and appropriate prescribing: Are we providing adequate training to future prescribers? South African Medical Journal, 107(5), 405-410

Weier, N., Thursky, K. & Zaidi, S.T. (2017). Antimicrobial knowledge and confidence amongst final year medical students in Australia. PLoS One, 12(8), e0182460

WHO [World Health Organisation]. (2018). Antimicrobial resistance (online). Available at: http:// www.who.int/en/news-room/fact-sheets/detail/anti microbial-resistance. Accessed 6th July, 2018

Yang, K., Dongfang, W., Fei, T., Shaojun, S., Xianxi, G., Qing, M., Xiaolian, Z. & Hong, C. (2016). Attitudes and perceptions regarding antimicrobial use and resistance among medical students in Central China. SpringerPlus, 5(1), 1779




How to Cite

Hanna, L.-A., McMichael, C., & Hall, M. (2019). What do future pharmacists know about, and think of, antimicrobial stewardship?. Pharmacy Education, 19(1), p 146–154. Retrieved from https://pharmacyeducation.fip.org/pharmacyeducation/article/view/670



Research Article