ORIGINAL ARTICLE
Bali Medical Journal (Bali MedJ) 2025.
Volume 14.
Number 3 : 770-776 P-ISSN.
E-ISSN: 2302-2914
Bibliometric study of PharmD involvement in antimicrobial stewardship and public health initiatives Anas Ali AlhurA*.
Renad AlbaqamiA.
Mastora AlotaibiA.
Shahd AlshamraniA.
Aseel MohammedA.
Nourah AlturaifiA.
Renad AlmutairiAA.
Khaled NahariA.
Kady AlsattamA.
Ahmed ZafaraniA.
Razan AlqarniA.
Layali AzyabiA.
Ruqayah Yahya.
Bandar AlqadiA.
Safar AlGhamdiA
ABSTRACT
Background: Doctor of Pharmacy (PharmD) professionals are central to antimicrobial stewardship (AMS) and public-health interventions, yet published research on their contributions is dispersed across various clinical and public-health domains.
Understanding publication trends, influential contributors, and emerging themes is essential to support evidence-based stewardship and guide future policy.
This study aimed to analyze global research involving PharmD participation in AMS and public-health initiatives from 2000 to 2024, focusing on publication patterns, collaboration networks, thematic clusters, and emerging research directions.
Methods: A bibliometric approach was conducted using OpenAlex as the sole data source.
A structured search identified English-language journal articles and reviews addressing PharmD or pharmacist involvement in AMS or public-health activities.
After duplicate removal and standardization using OpenRefine, the data were processed through Bibliometrix for descriptive and thematic analyses and VOSviewer for visual mapping of co-authorship, institutional collaboration, and keyword co-occurrence networks.
Outcomes included publication trends, core research themes, citation structures, and collaboration patterns across authors, institutions, and countries.
Results: A total of 629 publications met the inclusion criteria.
Annual output increased steadily, with a sharp rise after 2015 and peak productivity between 2019 and 2023.
AuAntibiotic Use and ResistanceAy was the most prominent theme .
= .
Keyword co-occurrence networks showed central clustering around Auantibiotic stewardship,Ay Aupharmacy,AyAuclinical pharmacy,Ay and Auantimicrobial resistance.
AyThe United States demonstrated the highest research productivity and strongest collaboration density, led by institutions such as the Veterans Health Administration and Duke University.
Emerging themes included COVID-19Aerelated stewardship, telepharmacy, diagnostic-guided prescribing, and community-level public-health interventions.
Most publications were original empirical studies .
= .
, complemented by a smaller body of reviews and other document types.
Conclusion: Research on PharmD involvement in AMS and public health has expanded significantly over the past two decades.
The field remains anchored in clinical stewardship while progressively incorporating diagnostic innovation, telepharmacy, and public-health responsibilities.
These trends highlight the growing global role of PharmD professionals in optimizing antimicrobial use and supporting public-health preparedness.
ADepartment of Health Informatics.
College of Public Health and Health Informatics.
University of Hail.
Hail.
Saudi Arabia ADepartment of Clinical Pharmacy.
College of Pharmacy.
Taif University.
Taif.
Saudi Arabia ADepartment of Clinical Pharmacy.
College of Pharmacy.
Imam Abdulrahman Bin Faisal University.
Dammam.
Saudi Arabia ADepartment of Pharmacy Practice.
College of Pharmacy.
Qassim University.
Buraidah.
Saudi Arabia AADepartment of Clinical Pharmacy.
Faculty of Pharmacy.
King Abdulaziz University.
Jeddah.
Saudi Arabia ACollege of Pharmacy.
King Khalid University.
Abha.
Saudi Arabia ADepartment of Pharmacy (PharmB).
College of Pharmacy.
Aljouf University.
Sakaka.
Saudi Arabia APharmacist.
Whites Pharmacy.
Jeddah.
Saudi Arabia ADepartment of Clinical Pharmacy.
College of Pharmacy.
Jazan University.
Jazan.
Saudi Arabia AADepartment of Clinical Pharmacy.
College of Pharmacy.
King Khalid University.
Abha.
Saudi Arabia *Corresponding Author Anas Ali Alhur.
Department of Health Informatics.
College of Public Health and Health Informatics.
University of Hail.
Hail.
Saudi Arabia.
alhur@gmail.
Received: 2025-09-14 Accepted: 2025-11-29 Published: 2025-12-25 Keywords: Antimicrobial Stewardship.
Antimicrobial Resistance.
Clinical Pharmacy.
PharmD.
Public Health.
Cite This Article: Alhur.
Albaqami.
Alotaibi.
Alshamrani.
Mohammed.
Alturaifi.
Almutairi, .
Nahari.
Alsattam.
Zafarani.
Alqarni.
Azyabi.
Yahya.
Alqadi.
AlGhamdi.
Bibliometric study of PharmD involvement in antimicrobial stewardship and public health initiatives.
Bali Medical Journal 14.
: 770-776.
DOI: 10.
15562/bmj.
INTRODUCTION
Antimicrobial (AMR) continues to pose a severe global health efforts across healthcare disciplines to promote responsible antimicrobial use and protect population health.
Meta770 analysis by Mathu et al showed that the incidence of AMR was high (>30%) to first-line antibiotics in the Middle East Antimicrobial (AMS) programs have emerged as a core strategy to optimize antimicrobial therapy, reduce inappropriate prescribing, and limit the spread of resistant organisms.
Pharmacists, particularly those with Doctor of Pharmacy (PharmD) training, have become central contributors to AMS implementation due to their advanced medicationmanagement expertise, and growing healthcare teams.
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ORIGINAL ARTICLE
Over the past decade, research has increasingly highlighted the expanding role of PharmD professionals in infectious guideline development, surveillance of antimicrobial consumption, and educational initiatives targeting both clinicians and the public.
8Ae11 Recent studies also emphasise the impact of pharmacist-led interventions in reducing antimicrobial misuse in hospital and primary care settings, particularly in countries prioritising national action plans against AMR.
12,13 Parallel to PharmD practitioners have taken on broader public health functions, such as vaccination campaigns, health promotion activities, community-based awareness programs, and population-level efforts to address medication safety and prevent communicable diseases.
14Ae17 Despite the increasing visibility of pharmacistsAo contributions, the literature on PharmD involvement in AMS and public health remains scattered across diverse journals, clinical specialties, and global contexts.
Several recent reviews describe pharmacistsAo roles in AMS implementation, but they often focus on specific settings .
, hospitals, emergency care, primary car.
and do not capture longitudinal trends, collaboration 18Ae21 Bibliometric analysis offers a systematic approach to mapping scientific production, identifying influential authors and institutions, visualising collaboration networks, and uncovering emerging themes in the field.
21 With the availability of large and open scholarly datasets such as OpenAlex, combined with advanced tools like Bibliometrix and VOSviewer, it is now possible to examine research output at scale and understand how PharmD-led AMS and public health initiatives have developed over time.
To date, there is no bibliometric study that evaluate this topic.
Therefore, this bibliometric study aims to analyse global research related to PharmD involvement in antimicrobial stewardship and public health initiatives from 2000 to 2024.
examining publication trends, influential contributors, thematic clusters, and emerging research topics, this work seeks to provide a comprehensive overview that can support future academic, clinical, and policy efforts to strengthen pharmacistled stewardship and public health
METHODS
Study Design This study used a quantitative bibliometric design to analyse global research related to PharmD involvement in antimicrobial stewardship (AMS) and public health The approach focused on examining publication patterns, influential contributors, collaboration networks, and thematic structures within the field.
Data Source and Search Strategy All records were retrieved exclusively from OpenAlex, an open and comprehensive scholarly database that provides detailed metadata on journal articles, authors, institutions, citations, and conceptual Its broad coverage and accessibility make it suitable for large-scale bibliometric research.
A structured search query was executed through the OpenAlex API to identify research discussing PharmD or pharmacist involvement in AMS or public health initiatives.
The OpenAlex API Query included: title_and_ search:(PharmD OR AuDoctor of PharmacyAy OR pharmacist OR Auclinical pharmacistAy OR Aupharmacist-ledA.
AND .
ntimicrobial stewardship OR Auantibiotic stewardshipAy OR AMR) AND (Aupublic healthAy OR Aucommunity healthAy OR Auhealth promotionA.
The filters applied for that search were: .
publication within range of years 2000Ae2024, .
type of article is original article or review article, .
article using English as main language.
Eligibility Criteria The inclusion criteria for this study are: .
research involving PharmD professionals, clinical pharmacists, or pharmacist-led interventions, .
studies focusing on AMS, antimicrobial resistance, or public health activities, .
peer-reviewed journal articles and review papers, and .
Englishlanguage publications.
While the exclusion criteria in this study are: .
studies lacking any pharmacist involvement, .
editorials, letters, commentaries, or nonAe peer-reviewed material, and .
duplicate records retrieved via the API.
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: 770-776 | doi: 10.
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Data Extraction.
Cleaning, and Standardisation Procedure The following metadata elements were collected: Article title.
Authors and affiliations.
Country of the corresponding author.
Year of publication.
Journal/ source.
Author keywords.
Citation counts.
Referenced works.
Concept categories.
The data were exported in JSON and CSV formats for analysis.
Data cleaning procedures included: removing duplicates, standardising author names, normalising variations in institutional names, and filtering out irrelevant records.
OpenRefine .
was used for text cleaning.
Cleaned data were then imported into RStudio and converted to a bibliometric data frame using the Bibliometrix package.
To minimize potential bias inherent First, a comprehensive and predefined search strategy was applied using standardized keywords and Boolean operators to reduce selection bias and ensure reproducibility.
Second, data retrieval was restricted to a single curated database to maintain consistency in indexing standards and citation metrics, thereby limiting database-related Third, duplicate records and non-relevant documents were systematically screened and excluded through a two-stage filtering process based on titles, abstracts, and full-text metadata.
Bibliometric Analysis The software used in this analysis are Bibliometrix (R packag.
for descriptive indicators, collaboration metrics, and thematic mapping.
We also used VOSviewer for constructing visual networks including co-authorship, keyword co-occurrence, and co-citation patterns.
The descriptive analysis included annual publication trends, leading authors, top journals, most productive countries and institutions, and citation trends.
Then we continued to collaboration analysis which evaluated author collaboration networks and international research cooperation.
also conducted thematic analysis to assess keyword co-occurrence patterns, thematic clusters and evolution and identification of dominant and emerging themes.
For co-citation analysis, we analyzed the most frequently co-cited authors and the ORIGINAL ARTICLE core references contributing to the field.
Network visualisations were produced using VOSviewer, and tabular results were generated using Bibliometrix.
Ethical Considerations The study relied entirely on publicly available metadata without human participants or identifiable personal Ethical approval was not RESULTS Annual output increased steadily from the early 2000s, followed by a marked rise after 2015, reaching its highest levels between 2019 and 2023.
After selection based on the inclusion and exclusion criteria, only 629 publications met those criteria and included in the analysis.
The year-by-year raw distribution is summarized in Table 1.
Two author-level structures were generated.
Figure 1 presents a small-scale author-collaboration network, highlighting direct links among key contributors.
Topic-frequency analysis identified AuAntibiotic Use and ResistanceAy as the most represented theme, appearing in 368 publications (Table .
Additional prominent topics included pharmaceutical care and patient outcomes, urinary-tract infection management, susceptibility testing, and drug-induced adverse These patterns align with the keyword co-occurrence structure illustrated in Figure 2, where Aumedicine,Ay Auantibiotics,Ay Aupharmacy,Ay Auclinical pharmacy,Ay and Auantibiotic stewardshipAy appear as central, high-frequency nodes.
Institutional analysis revealed that the U.
Department of Veterans Affairs and the Veterans Health Administration were the top contributors, each producing 27 publications (Table .
Other major institutions included: Henry Ford Health System / Henry Ford Hospital.
Duke University.
University of Pittsburgh, and University of Michigan The network (Figure .
demonstrates strong interconnectedness among major U.
hospitals and universities, with growing participation from institutions in India, the Middle East, and Latin America.
The country collaboration mapping (Figure .
shows that the United States serves as the central hub in global research Strong links connect the with: United Kingdom.
India.
Saudi Arabia.
China.
Spain.
Australia, and Canada.
These findings are supported by the country-level data extracted from Country_Nodes.
csv and Country_ Edges.
csv, which confirm that the U.
has the highest publication count and collaboration density in the dataset Figure The keyword co-occurrence network (Figure .
revealed several major knowledge clusters which is .
Antimicrobial/ Table 1.
Annual Publications .
0Ae Year Number of Publications .
Total Figure 1.
Antibiotic Cluster:
Auantibiotics,Ay Auantibiotic stewardship,Ay Auantimicrobial,Ay AuresistanceAy, .
Clinical/Pharmacy Cluster:
Aupharmacy,Ay Aupharmacist,Ay Auclinical pharmacy,Ay Aupharmaceutical careAy, .
Internal Medicine & Infectious Diseases Cluster: Auinternal medicine,Ay Auemergency medicine,Ay Ausepsis,Ay AubacteremiaAy, and .
Public Health / Quality Improvement Cluster: Auaudit,Ay Auintervention,Ay Auguideline,Ay AumultidisciplinaryAy.
These collectively demonstrate the strong clinical foundation of pharmacist-led antimicrobial stewardship (AMS) research and the breadth of topics connected to it (Figure .
The thematic map generated using Bibliometrix (Figure .
positioned themes according to centrality and development which is: .
motor themes: central and well-developed areas such as antibiotic stewardship and pharmacy practice, .
basic themes: foundational fields including medicine, internal medicine, and pharmacology, .
emerging themes:
COVID-19Aerelated Table 2.
Top Research Topics in PharmD-Led AMS Literature Topic Works .
Antibiotic Use and Resistance Pharmaceutical Practices and Patient Outcomes Urinary-Tract Infection Management Bacterial Identification and Susceptibility Testing Drug-Induced Adverse Reactions Infectious Disease Diagnostics Clinical Pharmacy Pharmacy Practice Medical Prescription Quality Antimicrobial Resistance Surveillance Micro-Level Author Collaboration Pathway in AMS Research Bali Medical Journal 2025.
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ORIGINAL ARTICLE
Table 3.
Most Productive Institutions Institution Works .
United States Department of Veterans Affairs Veterans Health Administration Duke University Henry Ford Health System Henry Ford Hospital University of Pittsburgh Amrita Institute of Medical Sciences University of Michigan University of Utah University of Minnesota Medical Center Wayne State University University of Rochester University of Iowa Houston Methodist University of Colorado Denver University of Maryland Mayo Clinic King Abdulaziz University Ministry of Health .
ultiple Universidad Byblica Latinoamericana preparedness, and telepharmacy, and .
niche themes: microbiology diagnostics, susceptibility testing, and biomarkerbased research.
These thematic patterns confirm that pharmacist-led AMS research continues to be anchored in infectious diseases while expanding toward healthsystem stewardship and public-health applications Figure 6.
The dataset consisted primarily of original research articles .
= .
Other document types included reviews, letters, book chapters, and preprints (Table .
This distribution indicates that AMS literature is largely driven by empirical investigations supported by a smaller body of secondary or commentary works.
DISCUSSION
The findings of this bibliometric study show a steady global expansion of research focused on PharmD contributions to Figure 2.
Keyword Co-Occurrence Network of Pharmacist-Led Antimicrobial Stewardship Research (VOSviewe.
Figure 3.
Institutional Collaboration Network in Pharmacist-Led Antimicrobial Stewardship Research (Time-Overlay Visualizatio.
antimicrobial stewardship (AMS) and public-health activities.
The increase in publications after 2015 coincides with rising international concern about antimicrobial resistance and the push for stronger multidisciplinary stewardship programs, as highlighted in earlier global reports and implementation studies.
Over the years, pharmacists with advanced clinical training have become deeply embedded in stewardship teams, and their impact has been documented across diverse healthcare settings.
Numerous studies have shown that pharmacist-led interventions improve prescribing quality, enhance therapeutic decision-making, and reduce unnecessary antimicrobial use.
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The concentration of research around topics such as antibiotic use, resistance trends, and clinical-pharmacy services reflects the continued centrality of pharmacists in stewardship efforts.
Prior evidence consistently demonstrates that pharmacists are key to developing AMS guidelines, monitoring antimicrobial prescribers through real-time clinical 8Ae10 The prominence of keywords related to pharmacy practice in the co-occurrence network further confirms that stewardship activities remain strongly anchored in the clinical responsibilities of PharmD professionals.
ORIGINAL ARTICLE
Figure 4.
International Collaboration Network in Pharmacist-Led Antimicrobial Stewardship Research Figure 5.
Full Keyword Co-Occurrence Network of Pharmacist-Led Antimicrobial Stewardship Research Institutions in the United States.
Veterans Health Administration, stood out as major This is consistent with longstanding findings that U.
pharmacists to take on active, patientfacing antimicrobial-optimization roles, with several studies reporting reductions in broad-spectrum therapy, lower infection complications, and improved adherence to stewardship protocols.
11Ae13 However, the growing presence of institutions from India.
Saudi Arabia, and Latin America reflects a broader global commitment to AMS.
These regions have introduced national AMR action plans in recent years, and the increase in publications suggests measurable progress in building stewardship capacity.
14Ae16 A key observation from the thematic analysis is the shift toward broader publichealth functions.
During the COVID-19 pandemic, pharmacists played vital roles in monitoring antimicrobial use, guiding prescribers, and mitigating inappropriate antibiotic demand, an issue frequently reported in pandemic-related prescribing 17Ae19 Their involvement in telepharmacy, vaccination campaigns, and outbreak preparedness demonstrates how the profession continues to adapt to new public-health challenges.
Another emerging area identified through the keyword and thematic analysis relates to diagnostic stewardship.
Several studies have shown that closer collaboration between pharmacists and microbiology laboratories improves the interpretation of rapid tests, supports more precise prescribing, and enhances early de-escalation of broad-spectrum 20,21 This reflects a growing emphasis on aligning pharmacy practice with diagnostic technologies to promote more targeted treatment approaches.
Overall, the findings illustrate a strong and widening global evidence base supporting PharmD professionals as essential contributors to AMS and public-health initiatives.
While the research landscape continues to grow, the distribution of publications across many journals and specialties suggests the need for more coordinated frameworks, shared methodologies, and multicountry comparative studies to guide future This study offers several strengths that enhance its contribution to the literature on PharmD involvement in antimicrobial stewardship (AMS) and public-health First, it provides one of the most comprehensive bibliometric assessments to date, covering a 25-year period and analyzing global publication trends, collaboration networks, and thematic evolution using two complementary tools.
Bibliometrix and VOSviewer.
Second, the exclusive use of the OpenAlex database ensured broad coverage of peer-reviewed publications from diverse regions and Third, the inclusion of multiple analytic components, descriptive indicators, co-authorship structures, institutional collaborations, keyword co-occurrence patterns, and thematic mapping, allowed for a multidimensional understanding of how PharmD-led AMS research has progressed worldwide.
These strengths collectively offer a detailed overview that can inform academic planning, stewardship policy development, and future research priorities.
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ORIGINAL ARTICLE
Table 4.
Document Types in the Dataset Document Type Count .
Articles Reviews Letters Book Chapters Preprints Conference Papers Editorials Dissertations Total
CONFLICT OF INTEREST
STATEMENT
Figure 6.
Keyword Density Visualization of Pharmacist-Led Antimicrobial Stewardship Research However, the study also has limitations.
The reliance on a single data source (OpenAle.
may have resulted in the omission of some publications indexed only in other databases such as Scopus or Web of Science.
Variability in author name spelling, institutional labeling, and keyword assignment, common challenges in bibliometric research, may introduce classification inconsistencies despite extensive data cleaning efforts.
Additionally, the analysis was limited to English-language publications, potentially underrepresenting contributions from nonAeEnglish-speaking countries.
Finally, bibliometric methods quantify publication patterns and thematic structures but do not evaluate the quality of individual studies or the real-world impact of pharmacist-led Future analyses combining multiple databases or incorporating systematic-review methods could address these gaps and provide deeper insight into the evidence base.
CONCLUSION
This bibliometric study highlights a robust and expanding global evidence base on PharmD involvement in antimicrobial stewardship (AMS) and public-health initiatives, with research output accelerating over the past decade alongside broader clinical scope, stronger collaboration networks, and increased urgency around antimicrobial resistance.
The thematic landscape confirms AMS as the core research anchor while showing strategic diversification into emerging priorities such as telepharmacy, outbreak community-level By mapping key authors, institutions, thematic clusters, and collaboration linkages, the study provides actionable intelligence to guide program scaling, policy alignment, and future research roadmaps, reinforcing the critical role of pharmacists in strengthening AMS and public-health impact worldwide.
ETHICAL APPROVAL
This study did not involve human participants or identifiable personal All analyses were conducted using publicly available bibliometric metadata from the OpenAlex database.
According to international guidelines for secondary data research, ethical approval was not INFORMEDCONSENT Not applicable, as the study did not involve human participants Bali Medical Journal 2025.
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The authors declare that there are no conflicts of interest related to the design, analysis, or publication of this study.
FUNDING STATEMENT
This research received no external funding.
The study was conducted independently without financial support from public, commercial, or nonprofit agencies.
AUTHOR CONTRIBUTIONS
Conceptualization: Anas Ali Alhur Methodology: Anas Ali Alhur.
Renad Albaqami.
Mastora Alotaibi A Data Curation: Shahd Alshamrani.
Aseel Mohammed A Bibliometric Analysis:
Renad Almutairi.
Khaled Nahari A Software (Bibliometrix/VOSviewe.
Kady Alsattam.
Razan Alqarni A Validation: Layali Azyabi.
Ruqayah Yahya A Formal Analysis: Bandar Alqadi.
Safar AlGhamdi A Writing Ae Original Draft: Anas Ali Alhur.
Nourah Alturaifi A Writing Ae Review & Editing: All A Visualization: Ahmed Zafarani.
Razan Alqarni A Supervision: Anas Ali Alhur A Project Administration: Anas Ali Alhur All authors reviewed and approved the final version of the manuscript.
ORIGINAL ARTICLE
REFERENCES