Antibiotic resistance is a growing global concern driven by the overuse and misuse of antibiotics, necessitating effective antimicrobial stewardship (AMS) programs. This thesis evaluates and optimizes AMS interventions across inpatient and outpatient healthcare settings to improve antibiotic prescribing, reduce antimicrobial resistance (AMR), and enhance clinical outcomes. A systematic review with meta-analysis was conducted to assess AMS interventions in both settings, highlighting effective strategies and the impact of multidisciplinary teams (AMS-MDT), including clinical pharmacists, on the successful implementation and execution of AMS. Findings from this review informed the design of a novel AMS-MDT escalating approach, implemented in a large tertiary care hospital. A before-and-after interventional study demonstrated that AMS-MDT interventions significantly improved clinical outcomes, reduced antibiotic consumption, and enhanced cost-effectiveness. A qualitative study then explored the barriers and facilitators of AMS implementation among healthcare professionals in outpatient settings. Based on these findings, a digital AMS intervention was designed, integrating local antimicrobial guidelines into a smartphone-based clinical decision support system. An interrupted time-series analysis assessed its impact, showing reduced antibiotic overuse, improved adherence to prescribing guidelines, and enhanced clinician engagement with AMS principles. The thesis underscores the pivotal role of clinical pharmacists in AMS programs, demonstrating their ability to optimize antibiotic use and improve patient care. Moreover, it highlights the effectiveness of digital health solutions in bridging gaps in AMS implementation. The research findings support the expansion of AMS strategies through policy integration, education, and technological innovations to ensure long-term sustainability. By combining systematic reviews, real-world interventions, qualitative research, and digital health innovations, this thesis provides comprehensive insights into AMS optimization, offering a framework for sustainable implementation in diverse healthcare settings. Future research should focus on scaling digital AMS tools, expanding AMS-MDT models, and fostering global collaboration to combat AMR effectively.
| Date of Award | 3 Nov 2025 |
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| Original language | English |
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| Supervisor | Barbara Conway (Main Supervisor) & Mamoon Al Deyab (Co-Supervisor) |
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