Antimicrobial stewardship

Antimicrobial stewardship (AMS) refers to coordinated efforts to promote the optimal use of antimicrobial agents, including drug choice, dosing, route, and duration of administration.[1]

Every time an antimicrobial agent is used, it applies selection pressure to microbial populations which can result in disruption to the normal microbiome (dysbiosis) as well as resistance to that agent, and even cross-resistance to other agents. Resistance can then spread to other microbes and to other host organisms. Antimicrobial agents can also have direct toxic effects on people and animals, including damage to kidneys, endocrine glands, liver, teeth and bones. Antimicrobial therapy is justified when the benefits outweigh these risks.

Contrary to popular belief, AMS does not aim to reduce the overall volume or frequency of antimicrobial use, although that often happens to occur with successful AMS interventions. The aims of AMS are to:

  • reduce/eliminate any unnecessary applications of antimicrobials, e.g. giving antibacterial drugs for viral infections, giving two antimicrobials when one would be sufficient
  • ensure that human and animal patients who need antimicrobials receive the optimal drug for them, at the correct time, at an effective dose, via the correct route, for the minimum effective duration
  • minimise environmental contamination with antimicrobial agents

While the primary driver for AMS is to preserve the effectiveness of the antimicrobial drugs we have, by slowing the development of antimicrobial resistance, it also has other important outcomes, including improving patient safety and reducing healthcare costs.

AMS interventions were first implemented in human hospitals, but are now increasingly common in every setting where antimicrobials are used, including primary care, aged care, dental care and veterinary medicine. Although AMS interventions often focus on prescribers, the general public also has an important role to play in AMS, in ensuring they always use and dispose of antimicrobials wisely.

AMS is a key focus of the World Health Organization and the World Organization for Animal Health.

In the U.S., within the context of physicians' prescribing freedom (choice of prescription drugs), AMS had largely been voluntary self-regulation in the form of policies and appeals to adhere to a prescribing self-discipline until 2017, when the Joint Commission prescribed that hospitals should have an Antimicrobial Stewardship team, which was expanded to the outpatient setting in 2020.

As of 2019, California and Missouri had made AMS programs mandatory by law.[2][3]

  1. ^ "Antimicrobial Stewardship: A competency-based approach". OpenWHO. Archived from the original on 2024-03-27. Retrieved 2024-03-27.
  2. ^ "California Senate Bill No. 1311". Archived from the original on 2020-04-21.
  3. ^ "Missouri Dept. of Health & Senior Services". Archived from the original on August 10, 2020. Retrieved September 19, 2019.