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data on all important clinical
outcomes.Third,wealsocomparedthe data on recommendations by the pharmacist, the ID clinical fellow, and the independent ID physician. This helped us understand pre- cisely the pitfalls and strengths of both strategies. Our study has several limitations. First, the cluster-randomization
design may have been unable to control all confounders and led to unbalanced baseline characteristics between the 2 groups. Second, this study collected only data on the amount of antibiotic con- sumption (DDD), not the day of therapy. Therefore, we were unable to thoroughly explore the pattern of antibiotic prescription in the 2 groups. In conclusion, this study has demonstrated that general pharmacists who have undergone a short ID training course can safely implement an antibiotic approval program. Although our study could not confirm the noninferiority of a pharmacist PPRA in the targeted antibiotic consumption, we did demonstrate noninferiority in terms of favorable clinical response. Further- more, there was no significant difference in terms of consumption of the targeted antibiotics, antibiotic expenditure, and other important treatment outcomes. From these findings, the strategy of using general pharmacists trained in the above manner appears safe; however, it may not be as efficient in reducing antibiotic consumption as antibiotic approval implemented by an ID clin- ical fellow. Therefore, using trained general pharmacists could be an alternative to ID specialists for antibiotic approval when resources are limited.
Acknowledgments. The authors thank Sajja Supornpun and all ward pharmacists in the In-patient Pharmacy Unit, Siriraj Hospital for their assis- tance. We thank the Edanz Group for editing a draft of this manuscript.
Financial support. This study was primarily supported by the Faculty of Medicine Siriraj Hospital and Health Systems Research Institute, Thailand.
Conflicts of interest. All authors report no conflicts of interest relevant to this article.
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