Antimicrobial Stewardship in Indian Tertiary Care Hospitals: Current Evidence, Implementation Challenges, and Future Perspectives
S. Jahnavi
Department of Pharmacy Practice, Krupanidhi College of Pharmacy, Bengaluru 560035, India.
Anil Dhakal
*
Department of Pharmacy Practice, Krupanidhi College of Pharmacy, Bengaluru 560035, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Antimicrobial resistance (AMR) has emerged as one of the most pressing global public health challenges, compromising the effectiveness of antimicrobial therapy and increasing morbidity, mortality, healthcare expenditure, and hospital stay. India bears a substantial burden of AMR owing to high antimicrobial consumption, inappropriate prescribing practices, inadequate infection prevention measures, and variable implementation of antimicrobial stewardship programmes (AMS). Strengthening AMS has therefore become a national priority to optimize antimicrobial use and limit the emergence and spread of resistant pathogens.
Objective: This review critically synthesizes the current evidence on antimicrobial stewardship programmes in Indian tertiary care hospitals, focusing on stewardship interventions, antimicrobial prescribing practices, AMR trends, implementation barriers, the role of clinical pharmacists, and future policy directions.
Methods: A narrative review of the literature was conducted using PubMed, Scopus, and Google Scholar, supplemented by reports from the World Health Organization (WHO), the Indian Council of Medical Research (ICMR), and the National Centre for Disease Control (NCDC). Peer-reviewed studies, surveillance reports, clinical guidelines, and policy documents published between January 2010 and March 2025 were reviewed and thematically synthesized.
Results: The available evidence consistently demonstrates that antimicrobial stewardship interventions—including prospective audit and feedback, antimicrobial restriction policies, guideline-directed prescribing, multidisciplinary collaboration, and pharmacist-led interventions—improve prescribing appropriateness, enhance adherence to treatment guidelines, reduce unnecessary broad-spectrum antimicrobial use, and support rational antimicrobial utilization. However, the effectiveness of AMS implementation varies considerably across healthcare institutions because of differences in diagnostic infrastructure, microbiological support, trained personnel, institutional commitment, and resource availability. Persistent challenges such as rising multidrug-resistant organisms, limited surveillance coverage, and inconsistent stewardship practices continue to impede national AMR containment efforts.
Conclusion: Antimicrobial stewardship programmes represent a cornerstone of efforts to combat AMR in India. Strengthening multidisciplinary stewardship teams, expanding diagnostic and surveillance capacity, integrating digital health technologies, and enhancing policy implementation are essential for improving antimicrobial use and preserving the effectiveness of existing antimicrobial agents. Continued investment in stewardship infrastructure, education, and research will be critical to achieving sustainable improvements in patient care and addressing the growing threat of antimicrobial resistance.
Keywords: Antimicrobial stewardship, antimicrobial resistance, antibiotic stewardship, tertiary care hospitals, India, clinical pharmacy, antimicrobial prescribing