Benchmarking antimicrobial stewardship practices in secondary care hospital settings in India: A narrative review

Antimicrobial resistance (AMR) poses a critical global health threat in India due to the high burden of infectious diseases and widespread misuse of antibiotics. Secondary care hospitals, being pivotal in the Indian healthcare system, require effective Antimicrobial Stewardship (AMS) programs to optimize antimicrobial use and combat AMR. However, significant barriers, such as limited resources, lack of trained personnel, and inadequate infrastructure, hinder AMS implementation. This narrative review evaluated the current state of AMS programs in secondary care hospitals in India. It examined their implementation, impact, challenges, and enablers. Successful case studies of AMS programs were analysed to highlight multidisciplinary approaches involving clinicians, pharmacists, microbiologists, and infection control teams. Key strategies, such as formulary restriction, prospective audit with feedback, antibiotic time-outs, and development of evidence-based guidelines, were identified and discussed. AMS programs have shown potential in improving antimicrobial usage, reducing AMR, and enhancing patient outcomes. Critical components for successful AMS implementation include leadership commitment, drug expertise, accountability, and continuous education. Identified challenges include inadequate funding, insufficient training, and resource limitations. Despite these barriers, examples of effective AMS programs demonstrate the feasibility of scaling these interventions with strong policy support and infrastructure development. Strengthening AMS programs in Indian secondary care hospitals is crucial for controlling AMR, improving patient outcomes, and preserving antimicrobial effectiveness. Overcoming existing barriers requires policy frameworks, funding, infrastructure development, and continuous training. Scaling up AMS efforts can significantly contribute to combating AMR at national and global levels. This review offers recommendations to rationalize AMS practices and enhance implementation in India.