Evaluation of Antimicrobial Stewardship Programme Implementation at Federal Medical Centre, Owerri, Imo State

Antimicrobial resistance is a growing global health threat accelerated by inappropriate antibiotic prescribing and dispensing practices. Antimicrobial stewardship programmes represent the evidence-based institutional response to reducing unnecessary antimicrobial use. The Federal Medical Centre in Owerri, Imo State, South East Nigeria, initiated an ASP in 2021, and this study evaluated its implementation fidelity and early outcomes. A mixed-methods design was employed, combining retrospective analysis of antibiotic prescribing data from 2020 to 2023 with qualitative key informant interviews with clinicians, pharmacists, and microbiologists. Prescribing data were evaluated for compliance with the hospital formulary, appropriateness of antibiotic selection, duration of therapy, and documentation of indication. Following ASP implementation, broad-spectrum antibiotic use declined by 18%, and documented indication compliance improved from 52 to 74%. Culture-guided prescribing increased from 28 to 46% of antibiotic courses. However, challenges including limited microbiological diagnostic capacity, high patient volumes, and inadequate pharmacist staffing constrained programme reach. Staff surveys indicated moderate knowledge of ASP principles but limited confidence in communicating antibiotic recommendations to prescribers. The study recommends sustainable investment in diagnostic capacity, pharmacist workforce development, and clinician ASP education to consolidate programme gains. Keywords: antimicrobial stewardship, antibiotic prescribing, Federal Medical Centre, Owerri, antimicrobial resistance.