Antimicrobial Stewardship Recommendations Generated During Pharmacist-Supervised Pharmacy Intern Reviews at a Tertiary Hospital in Aseer, Saudi Arabia: A Retrospective Descriptive Study

Background/Objectives: Pharmacist review is central to antimicrobial stewardship, yet data from southern Saudi Arabia are scarce. We described prescribing and the stewardship recommendations proposed when pharmacy interns reviewed antimicrobial therapy under infectious diseases pharmacist supervision at Aseer Central Hospital. Methods: We analyzed review checklists completed by 42 King Khalid University pharmacy interns in eight rotation blocks between January 2025 and May 2026 (11 of 17 months); encounters were documented reviews, not a representative sample of treated inpatients. Recommendation frequency by indication, culture documentation by ward and recommendation frequency between the two largest teams were compared with chi-square tests. Results: Of 622 forms, 606 encounters (903 antimicrobial entries) were analyzed. Piperacillin/tazobactam (21.3%), ceftriaxone (11.5%) and metronidazole (10.7%) were most frequent; Watch agents comprised 71.5% of classifiable antibacterial entries. A recommendation was proposed in 257 encounters (42.4%; 95% confidence interval (CI) 38.5 to 46.4); 126 (49.0%) asked to stop or narrow therapy. Recommendation frequency was 36.2% (95% CI 31.5 to 41.3) for empirical, 47.7% (39.4 to 56.2) for definitive and 62.6% (52.4 to 71.9) for prophylactic therapy (p < 0.001), robust to clustering and adjustment. Culture documentation varied across wards (14.5% to 66.7%; p < 0.001); the General Surgery to Medical difference was no longer significant after stratification by indication. A resistant organism label was documented in 8.7% of encounters. Conclusions: Proposed recommendations concentrated on a few broad-spectrum agents and on prophylaxis. Consultant approval, physician acceptance and outcomes were not measured, so the findings identify audit targets rather than stewardship effect.