Topic overview

Start with the big picture

A stewardship programme combines clinical decision-making with organisational support. Its core elements include leadership, accountability, antimicrobial expertise, action, tracking, reporting and education, delivered by a multidisciplinary team. Strategies such as pre-authorisation, audit and feedback, evidence-based guidelines, IV-to-oral switching, dose optimisation, de-escalation and stop dates help refine treatment. Local resistance data and antibiograms inform empiric choices; rapid diagnostics and therapeutic drug monitoring can support earlier targeted therapy. Programmes track measures such as antimicrobial use, guideline adherence, adverse outcomes, resistance trends and cost, then report findings to prescribers and leaders. Education and infection-prevention practices reinforce responsible prescribing and broader antimicrobial-resistance control.