Addressing barriers in antimicrobial stewardship: a guide from research to implementation

Abstract

AIM

This review aimed to identify barriers to the implementing Antimicrobial Stewardship (AMS) programs and recommend solutions to address these challenges.

BACKGROUND

Antimicrobial resistance (AMR) is a major global health threat and AMS programs are crucial for optimizing antimicrobial use and reducing resistance.

METHODS

A comprehensive literature review was conducted using PubMed, Scopus, and Google Scholar. Studies were selected based on predefined criteria focusing on barriers to AMS implementation.

RESULTS

Many countries lack or fail to implement National Action Plans (NAPs) on AMR; regulatory gaps like over-the-counter antibiotic sales have impact on AMS efforts. Preventive measures such as infection prevention and control, vaccination, sanitation and hygiene are often low priorities. Developing countries face resource constraints, including limited human resources, diagnostics, and antibiotic access. The absence of national guidelines and training exacerbates knowledge gaps. Siloed work environments often inhibit interdisciplinary collaboration; cultural habits, prescriber autonomy, self-medication, patient compliance, poor surveillance data, and pharmaceutical industry influence pose additional barriers to AMS.

To overcome these barriers, governments should enforce NAPs, establish strict regulatory frameworks, and prioritize preventive measures. Strong leadership, integration of AMS into national policies, and resource allocation are crucial. Bridging knowledge gaps through guidelines and training, promoting interdisciplinary collaboration, and raising public awareness are essential. Regulating the pharmaceutical industry, investing in robust surveillance systems, and evaluating principles are also important tools.

CONCLUSIONS

Overcoming AMS barriers needs a holistic approach. Addressing these barriers can bridge the gap between scientific evidence and real-world practices, leading to more effective AMR management.