American Hospital Association
Health Research & Educational Trust

Antibiotic Stewardship


The Infectious Disease Society of America defines antibiotic stewardship as “coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration. Antimicrobial stewards seek to achieve optimal clinical outcomes related to antimicrobial use, minimize toxicity and other adverse events, reduce the costs of health care for infections, and limit the selection for antimicrobial resistant strains.” Promoting Antimicrobial Stewardship in Human Medicine, Infectious Disease Society of America.

Resistance has since extended to virtually every antibiotic. The causes are multiple: natural abilities of bacteria to mutate and evolve into resistant strains, sharing of resistance capabilities amongst bacteria of the same or different species, and overuse and abuse of antibiotics. Studies show that between 30-50% of both inpatient and outpatient antibiotic prescriptions either are unnecessary or erred in drug, dose, or duration. Furthermore, development of new classes of antibiotics that work through novel mechanisms has dramatically slowed.  The Centers for Disease Control and Prevention (CDC) reports that drug-resistant bacteria cause 23,000 deaths and 2 million illnesses each year. Avoidable costs from antibiotic misuse range from $27 billion to $47 billion per year in the United States.

This Change Package synthesizes the literature and presents to you the why, what, and how (and what not to do!) for the implementation of a successful antibiotic stewardship program (ASP). It discusses the roles of administration, pharmacists, physicians, and nursing and is referenced with key resources and hyperlinks.

And there is something for everybody, big or small. It is accompanied by two case studies, one highlighting how a successful ASP has developed in a large medical center in Mississippi, and the other highlighting a world class ASP in a small Critical Access Hospital in Colorado.