Antimicrobial Stewardship in Low- and Middle-Income Countries

Purpose of review Antimicrobial stewardship (AMS) is one of the core elements of infection prevention and control, but in many resource-limited countries its implementation is absent or suboptimal. There is inadequate information on the best model for an AMS program. AMS should be adapted to each region according to sociocultural dimensions, financing, and antimicrobial resistance. Recent findings Many of antimicrobials prescribed in hospitals are inappropriate or unnecessary, increasing the risk of adverse reactions and antimicrobial resistance. AMS programs are of essential benefits in low- and middle-income countries (LMIC) where high level of antimicrobial resistance is reported. Low-quality and/or counterfeit antimicrobials and self-medication are known problems in LMIC opposing to adequate AMS programs. AMS programs must be present in all scenarios and should be context- and culture-adapted, balancing effectiveness and cost of different strategies. Analysis of AMS programs should be done at each institution of the country and its health system. Diagnostic algorithms and treatment guidelines should be readily available and should be context adapted based on local epidemiology and bacterial resistance. Multidisciplinary groups should be created to improve AMS in each region, including human health, veterinary, and agriculture.