Abstract
Background: Antimicrobial stewardship programs (ASPs) are required within Canadian acute-care accreditation, yet implementation remains uneven, particularly in smaller hospitals and settings with limited on-site infectious diseases (ID) expertise. Because health care is organized provincially, Canada offers several stewardship models rather than a single national operating structure.
Objective: To examine pharmacist-led antimicrobial stewardship in Canada through a comparison of provincial approaches and identify transferable strategies for hospitals with limited specialist resources.
Methods: A narrative review was informed by the 2025 Canadian Nosocomial Infection Surveillance Program (CNISP) survey and current provincial stewardship resources from Ontario, Alberta, British Columbia, Saskatchewan, and Quebec.
Results: Among 106 CNISP hospitals surveyed in 2024, 84% reported a formal ASP; every hospital with an ASP included a pharmacist, 90% performed prospective audit and feedback, and 85% conducted quantitative antimicrobial-use surveillance. Most hospitals without a formal ASP were small sites. Provincial approaches differ: Ontario emphasizes province-wide surveillance and benchmarking; Alberta is implementing an integrated provincial acute-care program; British Columbia coordinates health-authority stewardship through provincial expert networks; Saskatchewan uses a centralized provincial program supported by pharmacists, decision-support tools, and direct clinical review; and Quebec has a long-standing model of centrally developed antibiotic-use guidance. Across these systems, pharmacist leadership is most effective when linked to physician partnership, microbiology, data infrastructure, and access to ID consultation.
Conclusion: Canadian experience supports a hub-and-spoke model in which pharmacists provide local daily stewardship while provincial or regional systems supply specialist support, guidelines, surveillance, education, and escalation pathways. This structure is particularly relevant to smaller hospitals that cannot sustain full-time on-site ID services.
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Ethics & Declarations
Author Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by all authors. All authors read and approved the final manuscript.
Ethics Approval and Consent to Participate
Not applicable. This study did not involve human participants, animal experimentation, or confidential patient clinical data.
Consent for Publication
Not applicable, or informed consent for publication was obtained from all individual participants where relevant.
Competing Interests
The authors declare that they have no competing financial or non-financial interests.
Funding
The authors declare that no funds, grants, or other financial support were received during the preparation of this manuscript.
Data Availability Statement
Data sharing is not applicable to this article as no new datasets were generated or analyzed during the current study.
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© 2026 Mohamed Abdellatif et al. International Journal of Clinical Pharmacy and Medicine.