Pharmacist Contributions in Promoting Appropriate Antimicrobial Use toward Combating Antimicrobial Resistance in Japan

Antimicrobial resistance (AMR) has become a major global health threat, prompting the implementation of antimicrobial stewardship (AS) programs to optimize antimicrobial use. Pharmacists play a vital role in these efforts. In Japan, a series of national policy measures has been launched as part of the 2016 National Action Plan on AMR, and systems have been established in parallel to support the active involvement of pharmacists with advanced expertise in infectious diseases. This narrative review provides an overview of the expanding contributions of pharmacists to AS across diverse healthcare settings in Japan. In large hospitals with relatively abundant human resources, pharmacists have promoted post-prescription review, dose optimization, and de-escalation, resulting in reduced use of broad-spectrum antibiotics, shortened treatment durations, cost savings, and even lower resistance rates. Further, in small- and medium-sized hospitals, where infectious disease specialists are often unavailable, pharmacist-led stewardship efforts are gradually emerging. Community pharmacists have also expanded AS efforts outside hospital settings by surveilling outpatient antibiotic prescriptions and identifying leftover antibiotics during home visits. In addition, multicenter collaborative studies and analyses using large-scale administrative claims databases are contributing to the generation of robust real-world evidence, facilitating sustained surveillance and policy evaluation. To maintain and further enhance these efforts, fostering the next generation of AS professionals and developing novel indicators and predictive models are essential. Pharmacist-led AS in Japan is expected to continue progressing, with sustainable contributions needed across healthcare situations of all field.