Designing a Pharmacist-Led Antimicrobial Stewardship Programme for Secondary Hospitals in North Central Nigeria

Antimicrobial stewardship programmes are essential for curbing antibiotic resistance, yet their implementation in Nigerian secondary hospitals remains nascent. This study developed and validated a pharmacist-led antimicrobial stewardship programme framework specifically designed for secondary hospitals in the North Central geopolitical zone of Nigeria. A mixed-methods programme development approach was employed, consisting of situational analysis, stakeholder consultation, and expert panel validation. The situational analysis involved antibiotic point prevalence surveys at eight secondary hospitals in Plateau, Niger, and Kwara States, revealing antibiotic use rates of 74.2 percent with broad-spectrum agents accounting for 61.5 percent of prescriptions. Stakeholder consultations were conducted with 45 healthcare workers including pharmacists, medical officers, nurses, and infection prevention officers to identify programmatic needs. An expert panel of twelve senior hospital pharmacists and infectious disease physicians reviewed and validated the proposed programme framework using a modified Delphi consensus method. The final framework encompasses core elements of antibiotic prescribing authorisation, mandatory de-escalation review at 48 to 72 hours, antibiogram development, prescriber audit and feedback, pharmacist-physician daily liaison, and quarterly outcome reporting. Expert consensus was achieved on all nine framework components, with 89 percent agreement on pharmacist co-leadership as a central feature. The study recommends adoption of this framework as a standard stewardship model for secondary hospitals in North Central Nigeria and calls on hospital management to formally incorporate pharmacists into infection control committees.

Keywords: antimicrobial stewardship, secondary hospitals, pharmacist-led programme, North Central Nigeria, antibiotic resistance