Impact of clinical pharmacist-led antimicrobial stewardship on prescribing optimization and economic outcomes in a Chinese county hospital: a retrospective cohort study

Background Clinical pharmacist-led antimicrobial stewardship (AMS) programs have proven effective in tertiary care, yet rigorous pharmacoeconomic evidence from primary care remains limited. This study evaluates the cost-effectiveness of clinical pharmacist consultation in a Chinese county hospital setting.Research design and methods This retrospective cohort study analyzed 200 hospitalized patients (March to December 2024). The intervention group (n = 100) received pharmacist-led AMS including pre-prescription review and therapeutic monitoring. The control group (n = 100) received standard care without pharmacist consultation. Primary outcomes were antimicrobial therapy costs and duration.Results Pharmacist-led AMS reduced antimicrobial costs by 52% (mean difference: ¥290.43, 95% CI: -428.29 to -152.56; p < 0.001) and therapy duration by 23% (7.0 vs. 9.1 days; p < 0.001). Cost savings were most pronounced in patients without obvious infection focus (97% reduction). Clinical efficacy was comparable between groups despite higher baseline severity in the intervention group.Conclusions Clinical pharmacist-led AMS achieves substantial cost containment and prescribing optimization in county-level hospitals without compromising clinical safety. These findings support expanding clinical pharmacy services as a cost-effective strategy for antimicrobial resistance containment in resource-limited settings.