Implementing Antibiotic Stewardship Programs in Secondary Health Facilities: A Practical Framework for Pharmacists in Sokoto State, North West Nigeria

Antibiotic stewardship programs represent a structured approach to optimizing antimicrobial use and reducing the development of drug-resistant organisms. Their implementation in secondary health facilities across North West Nigeria has been largely uncoordinated and inconsistent. This study developed and evaluated a practical antibiotic stewardship framework applicable to secondary health facilities in Sokoto State. A mixed-methods approach was employed, combining baseline prescription audit of 600 records across six hospitals, structured interviews with 40 pharmacists and physicians, and participatory framework development workshops. The baseline audit revealed that 74 percent of antibiotic prescriptions did not comply with established guidelines and that 29 percent of prescribed antibiotics were broad-spectrum agents used for first-line empiric therapy in uncomplicated infections. Key barriers to stewardship implementation included inadequate microbiology laboratory capacity, absence of local antibiograms, and limited interdisciplinary collaboration. The resulting framework prioritized prospective audit and feedback, formulary restriction of key broad-spectrum agents, and prescriber education modules delivered by pharmacists. A pilot implementation in three hospitals over six months demonstrated a 21 percent reduction in antibiotic use density and a significant improvement in guideline concordance. These findings demonstrate that pharmacist-led stewardship programs are feasible in Sokoto State's secondary facilities and should be mandated through state health policy. Keywords: antibiotic stewardship, secondary health facilities, Sokoto State, antimicrobial resistance, pharmacist-led program