i. Rationale, aims and objectives Antimicrobial Stewardship programs are critical for promoting and monitoring judicious use of antimicrobials, however, there are many well-established barriers to their effective implementation the rural setting. Pharmacist involvement in such programs is recommended as part of a multidisciplinary approach to improve appropriate antimicrobial prescribing. The aim of this study was to describe the impact of implementing a clinical pharmacy service on antimicrobial prescribing in a rural GP led hospital; explore areas of suboptimal antimicrobial prescribing; and review the change in total antimicrobial cost per patient day. ii. Methods: A retrospective case series audit of pre- and post-implementation of a new clinical pharmacy service was undertaken. All adult patients who had presented with sepsis, cellulitis, urinary tract infections and pneumonia between May and August 2015 and repeated for months in 2018 were included. Appropriateness of therapy was assessed using the National Antimicrobial Prescribing Survey guidelines. iii. Results: A total of 115 antibiotic orders from 2015 and 158 orders from 2018 were included. During admission, 86% of patients (55/64) in the post-intervention group were reviewed by a clinical pharmacist. Appropriate prescribing increased from 57% (66/115) in 2015 to 82% (129/158) in 2018 (P=0.001). Ceftriaxone was the most inappropriately prescribed antimicrobial. The cost of antimicrobial therapy was halved from $10.00 to $5.33 per patient day, pre- and post-implementation of a clinical pharmacy service respectively. iv. Conclusions: The implementation of a clinical pharmacy service in a small rural GP led hospital can significantly improve antimicrobial prescribing practices and provide considerable cost savings. Keywords Antimicrobial stewardship; antibiotics; pharmacists; hospitals, Rural; Inappropriate Prescribing