Antimicrobial resistance has been described by the World Health Organisation as a major global health threat, with over 4.7 million associated deaths worldwide in 2021. Antimicrobial resistance can be found in bacteria, fungi, viruses and parasites.

As a result there is higher mortality and morbidity among infected individuals and there are fewer options for treatment.¹ Antimicrobial resistance is also listed on the UK Government’s National Risk Register, which is the government’s assessment of the most serious risks facing the country.²  

The National Institute for Health and Care Excellence (NICE) defines antimicrobial stewardship as 'an organisational or healthcare‑system‑wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness'.³ NICE has produced a set of quality statements for antimicrobial stewardship covering the effective use of antimicrobial medicines in all settings for all types of antimicrobials for treating bacterial, fungal, viral and parasitic infections, including:⁴

Statement 1: People with a self-limiting condition, as assessed by a primary care prescriber, receive advice about self-management and adverse consequences of overusing antimicrobials. 

Statement 2: Prescribers in primary care can use back-up (delayed) antimicrobial prescribing when there is clinical uncertainty about whether a condition is self-limiting or is likely to deteriorate.

Statement 3: People prescribed an antimicrobial have the clinical indication, dose and duration of treatment documented in their clinical record.

Statement 4: People in hospital who are prescribed an antimicrobial have a microbiological sample taken and their treatment reviewed when the results are available.

Statement 5: Individuals and teams responsible for antimicrobial stewardship monitor data and provide feedback on prescribing practice at prescriber, team, organisation and commissioner level.

Statement 6 (developmental statement): Prescribers in secondary and dental care use electronic prescribing systems that link indication with the antimicrobial prescription.

Based on NICE Clinical Knowledge Summaries (CKS). Reproduced and adapted under licence from Clarity Informatics Limited t/a as Agilio Software.

The main aims of antimicrobial stewardship are to:⁵

– optimise antimicrobial therapy for individual patients

– prevent overuse, misuse, and abuse of antimicrobials

– minimise development of resistance at patient and community levels

– prevent unintended harm through adverse drug reactions and healthcare-association infections