Antimicrobial stewardship in acute exacerbations of COPD: a qualitative study of hospital pharmacists’ perspectives
7 affiliations
- 1Faculty of Medicine and Health, Sydney Pharmacy School, The University of Sydney, Camperdown, Sydney, NSW Australia
- 2Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Al Qassim, Saudi Arabia
- 3The University of Sydney Institute for Infectious Diseases, Sydney, NSW Australia
- 4Westmead Hospital, Sydney, NSW Australia
- 5Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW Australia
- 6Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, NSW Australia
- 7The Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW Australia
Abstract
Introduction: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a common cause of antibiotic use and hospital admissions. Although antimicrobial stewardship (AMS) programs are well established, the specific contribution of pharmacists to COPD-related antimicrobial decision-making remains unclear.
Aim: To explore hospital pharmacists’ perspectives on their roles, responsibilities, and application of AMS principles in the management of hospitalised patients with COPD exacerbations.
Method: We conducted a qualitative study using semi-structured interviews with hospital pharmacists involved in COPD care and/or AMS activities at two public tertiary hospitals in Sydney, Australia. Our research was informed by a constructivist epistemology and critical realist orientation. Interviews were conducted via Zoom, audio-recorded, transcribed verbatim, and analysed inductively using reflexive thematic analysis. Recruitment continued until data saturation was reached.
Results: Seventeen pharmacists participated and three themes were identified. First, pharmacists described AMS as being a core component of their professional role, including reviewing antimicrobial indication, dose, duration, and spectrum, and promoting appropriate antimicrobial use. However, their involvement typically occurred after initial prescribing, with greater influence on treatment duration than agent selection. Second, organisational and structural factors shaped their scope of practice, including workload pressures, hierarchical prescribing cultures, limited prescribing authority, and electronic system challenges, particularly during transitions of care. Third, pharmacists described patient-centred roles alongside stewardship, including counselling on antibiotic use and discharge medicines, as well as support for inhaler technique, vaccination, and smoking cessation.
Conclusion: Hospital pharmacists view AMS as a core part of managing COPD exacerbations. Their contributions include antimicrobial review, interdisciplinary communication, and patient education, but their involvement is often advisory and constrained by organisational structures, workload, and prescribing hierarchies.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s11096-026-02217-w.
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BibTeX
@article{alrashdi2026antimicrobial,
title = {{Antimicrobial stewardship in acute exacerbations of COPD: a qualitative study of hospital pharmacists’ perspectives}},
author = {Abdulaziz Alrashdi and Jan-Willem C. Alffenaar and Jin-Gun Cho and Bandana Saini},
journal = {International Journal of Clinical Pharmacy},
year = {2026},
month = sep,
doi = {10.1007/s11096-026-02217-w},
url = {https://doi.org/10.1007/s11096-026-02217-w},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Antimicrobial stewardship in acute exacerbations of COPD: a qualitative study of hospital pharmacists’ perspectives
AU - Abdulaziz Alrashdi
AU - Jan-Willem C. Alffenaar
AU - Jin-Gun Cho
AU - Bandana Saini
PY - 2026
DA - 2026/09/15
JO - International Journal of Clinical Pharmacy
DO - 10.1007/s11096-026-02217-w
UR - https://doi.org/10.1007/s11096-026-02217-w
AB - Introduction: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a common cause of antibiotic use and hospital admissions. Although antimicrobial stewardship (AMS) programs are well established, the specific contribution of pharmacists to COPD-related antimicrobial decision-making remains unclear. Aim: To explore hospital pharmacists’ perspectives on their roles, responsibilities, and application of AMS principles in the management of hospitalised patients with COPD exacerbations. Method: We conducted a qualitative study using semi-structured interviews with hospital pharmacists involved in COPD care and/or AMS activities at two public tertiary hospitals in Sydney, Australia. Our research was informed by a constructivist epistemology and critical realist orientation. Interviews were conducted via Zoom, audio-recorded, transcribed verbatim, and analysed inductively using reflexive thematic analysis. Recruitment continued until data saturation was reached. Results: Seventeen pharmacists participated and three themes were identified. First, pharmacists described AMS as being a core component of their professional role, including reviewing antimicrobial indication, dose, duration, and spectrum, and promoting appropriate antimicrobial use. However, their involvement typically occurred after initial prescribing, with greater influence on treatment duration than agent selection. Second, organisational and structural factors shaped their scope of practice, including workload pressures, hierarchical prescribing cultures, limited prescribing authority, and electronic system challenges, particularly during transitions of care. Third, pharmacists described patient-centred roles alongside stewardship, including counselling on antibiotic use and discharge medicines, as well as support for inhaler technique, vaccination, and smoking cessation. Conclusion: Hospital pharmacists view AMS as a core part of managing COPD exacerbations. Their contributions include antimicrobial review, interdisciplinary communication, and patient education, but their involvement is often advisory and constrained by organisational structures, workload, and prescribing hierarchies. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s11096-026-02217-w.
SN - 2210-7703
SN - 2210-7711
ER -