Antimicrobial Stewardship

Antimicrobial stewardship is the organised effort within a healthcare facility to ensure that patients receive antibiotics only when needed and in the most appropriate manner. It promotes rational antibiotic use by optimising the choice, dose, route and duration of treatment according to clinical evidence, microbiological findings and local resistance patterns. Its purpose is to improve patient outcomes while limiting adverse effects, unnecessary expenditure and antimicrobial resistance.

Institutional framework

Stewardship converts individual prescribing into a coordinated, accountable hospital programme involving clinicians, microbiologists, pharmacists, nurses and infection-control personnel.

• Facility leadership should provide responsibility, trained personnel and resources for an antimicrobial stewardship programme.
• A multidisciplinary stewardship team should develop facility-specific policies based on national guidance and the local antibiogram.
• Regular training helps prescribers distinguish bacterial infections from conditions in which antibiotics offer no benefit.

Interventions for rational prescribing

• Evidence-based treatment guidelines and antibiotic formularies guide the appropriate drug, dose, route and duration for common infections.
• Diagnostic samples should, where clinically appropriate, be collected before treatment so that therapy can later be matched to culture and susceptibility results.
• Prospective audit and feedback reviews ongoing prescriptions and advises prescribers on continuation, modification or discontinuation.
• Pre-authorisation or restriction may be applied to selected broad-spectrum or last-resort antibiotics.
• Periodic review enables de-escalation from broad-spectrum to narrow-spectrum therapy, intravenous-to-oral conversion and timely stopping of treatment.

Monitoring and complementary measures

Facilities monitor antibiotic consumption, prescribing quality, resistance patterns and clinical outcomes, then use feedback to improve practice. Stewardship works alongside infection prevention and control, because preventing healthcare-associated infections reduces the need for antibiotics and the spread of resistant organisms.

• Prescription review can assess whether the indication, microbiological testing and planned treatment duration are documented.
• Surveillance findings help update local treatment guidelines and detect inappropriate prescribing patterns.

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