Antimicrobial Stewardship in Infectious Disease Management

Antimicrobial stewardship constitutes a coordinated set of interventions designed to optimise the use of anti-infective agents, improve patient outcomes, and limit the emergence and spread of antimicrobial resistance. Central to this approach is the development and enforcement of evidence-based prescribing guidelines, the routine review and de-escalation of empirical therapy, and the integration of rapid diagnostic tools to inform targeted treatment. Effective programmes engage multidisciplinary teams—clinicians, pharmacists, microbiologists and infection control specialists—to monitor antibiotic consumption, assess local resistance patterns, and provide education and feedback to prescribers. At a policy level, stewardship underpins national action plans, influences regulatory frameworks and guides investment in new agents, diagnostics and vaccines. Globally, stewardship efforts adapt to resource constraints, varying disease burdens and health-system infrastructures, highlighting the need for scalable models in both high- and low-income settings. By combining surveillance data, behavioural insights and quality improvement methodologies, antimicrobial stewardship fosters responsible prescribing practices, reduces healthcare costs linked to resistant infections and preserves the efficacy of existing therapies for future generations.

Research from Nature Portfolio

Recent work has illuminated the role of substandard and falsified medicines in driving resistance. Detailed analyses of active pharmaceutical ingredient variability demonstrate that inadequate drug exposure can select for resistant strains or, conversely, fail to sustain resistance under certain conditions. Modelling studies underscore the importance of mapping the spatial and temporal distribution of poor-quality products to inform regulatory and quality-assurance interventions. These insights emphasise that antimicrobial stewardship must extend beyond prescribing behaviour to encompass the integrity of supply chains and the enforcement of manufacturing standards.

Antimicrobial Stewardship in Infectious Disease Management publication trend

The graph below shows the total number of articles in antimicrobial stewardship in infectious disease management across all publications each year (not limited to Nature Index journals).

Technical terms

Antimicrobial stewardship: Coordinated interventions to optimise antimicrobial use, improve outcomes and limit resistance.

Antimicrobial resistance (AMR): The ability of microorganisms to survive exposure to an antimicrobial agent that would normally inhibit or kill them.

Defined daily dose (DDD): A standardised measure of drug consumption, defined as the assumed average maintenance dose per day for a drug used for its main indication in adults.

National action plan (NAP): A strategic framework adopted by a country to coordinate policy design, implementation tools and monitoring for antimicrobial resistance.

De-escalation: The process of narrowing antimicrobial therapy based on microbiological results or patient response.

Rapid diagnostics: Tests that quickly identify pathogens or resistance markers to guide timely and appropriate therapy.

References

1. Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050. The Lancet (2024).
2. Measuring the global response to antimicrobial resistance, 2020–21: a systematic governance analysis of 114 countries. The Lancet Infectious Diseases (2023).
3. The uncertain role of substandard and falsified medicines in the emergence and spread of antimicrobial resistance. Nature Communications (2023).
4. Global antibiotic consumption and usage in humans, 2000–18: a spatial modelling study. The Lancet Planetary Health (2021).