Challenges and opportunities for antimicrobial stewardship in resource-rich and resource-limited countries

Karolin Hijazi* (Corresponding Author), Chaitanya Joshi, Ian M Gould

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)
22 Downloads (Pure)


Introduction: Inappropriate prescription practices, patient and provider knowledge and attitudes, variable availability of diagnostics and surveillance systems, and the unrestricted use of antimicrobials in animals and plants are contributory factors to the global crisis of antimicrobial resistance (AMR).

Areas covered: Notwithstanding that interventions to revert AMR should be tailored to the socio-politico-economic landscape, there is global consensus for the implementation and enhancement of antimicrobial stewardship strategies. Yet the implementation of Antimicrobial Stewardship Programs (ASPs) remains relatively limited within healthcare settings and faces complex challenges in resource-limited countries. The current review summarizes the limitations of current ASPs, translation challenges in resource-limited countries, and potential solutions.

Expert opinion: Suboptimal ASP implementation in hospitals is multifactorial. Restriction of antimicrobial use should be informed by risk-benefit analyses, including the potential for substitute prescribing, and displacement of selection pressures. Thresholds in population use of antibiotics above which AMR increases may provide quantitative targets for ASPs. Horizontal and vertical collaborations involving policymakers and the general public are of paramount importance. While impactful prescribing changes require sustained engagement of the public and healthcare professionals, we warn against over-estimating the benefits of behavioral interventions. We advocate for population level stewardship interventions in addition to investment in structural factors that will aid ASP implementation.
Original languageEnglish
Pages (from-to)621-634
Number of pages14
JournalExpert Review of Anti-infective Therapy
Issue number8
Early online date15 Jul 2019
Publication statusPublished - 2019


  • antimicrobial resistance
  • antimicrobial stewardship
  • mainstreaming
  • regional cooperation
  • One Health
  • resource-limited countries
  • tiered national-level model
  • Antimicrobial resistance
  • CARE


Dive into the research topics of 'Challenges and opportunities for antimicrobial stewardship in resource-rich and resource-limited countries'. Together they form a unique fingerprint.

Cite this