Antimicrobial Stewardship

Antimicrobial stewardship refers to programs for interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration. Antimicrobial stewards seek to achieve optimal clinical outcomes related to antimicrobial use, minimize toxicity and other adverse events, reduce the costs of health care for infections, and limit the selection for antimicrobial resistant strains. Currently, there are no national or coordinated legislative or regulatory mandates designed to optimize use of antimicrobial therapy through antimicrobial stewardship. Given the societal value of antimicrobials and their diminishing effectiveness due to antimicrobial resistance, Infectious Diseases Society of America (IDSA) supports broad implementation of antimicrobial stewardship programs across all health care settings.

The end user, that is the patient and his family member and friends, must be made aware of antimicrobial stewardship. Unplanned use of antibiotics may make them render inefficacious, making important infections untreatable.

Antibiotic stewardship refers to a set of coordinated strategies to improve the use of antimicrobial medications with the goal of enhancing patient health outcomes, reducing resistance to antibiotics, and decreasing unnecessary costs.


Antimicrobial stewardship is defined by the selection of dosage and duration of antimicrobial treatment that results in the best clinical outcome for the treatment or prevention of infection.

What are the key points to Improve Antibiotic Use?

Categorize the specific interventions: pharmacy, infection and syndrome specific. Prioritize the policies of the hospitals by measures of overall use and other tracking and reporting metrics.

What policies can support optimal antibiotic use?

Document dose, duration, and indication. Develop and implement facility specific treatment recommendations.

How can you track antibiotic use and its outcomes?

Monitor closely the prescription of antibiotic and justify its use based on interventions. Measure antibiotic use as either days of therapy (DOT) or defined daily dose (DDD). Track clinical outcomes based on the use of antibiotics. Stewardship programs should provide regular updates on antibiotic prescribing, antibiotic resistance, and infectious disease management.


Antimicrobial Stewardship: A competency-based approach

While we are aware that antibiotics are most important breakthrough of the 20th century, there are however misuse of these. In order to preserve the utility of these life -saving drugs we all must use antibiotics wisely and this is the key intervention of “Antimicrobial stewardship”.

The Joint Commision has announced New Antimicrobial Stewardship Standard. Examples of leadership commitment to an antimicrobial stewardship program are as follows:

  • Accountability documents
  • Budget plans
  • Infection prevention plans
  • Performance improvement plans
  • Strategic plans
  • Using the electronic health record to collect antimicrobial stewardship data