Antimicrobial Stewardship in Low-Resource Hospitals: Barriers and Practical Interventions

Abstract

Antibiotics are used heavily in hospitals everywhere, but the conditions that make stewardship hardest, thin laboratory services, limited specialist staff, uncertain drug supply and weak surveillance, are the same conditions in which resistant infection does the most damage. This narrative review asks what is known about the barriers to antimicrobial stewardship in low-resource hospitals and which practical interventions the published literature supports. It draws on work on the burden and drivers of resistance, on the design and components of stewardship programmes, on prescribing behaviour, on diagnostic capacity and on the few programme reports from middle-income hospitals, and it reports no new data and no local findings. Barriers cluster around diagnostics, workforce, medicine supply and governance rather than around knowledge alone. Low-cost measures such as written local guidelines, documentation of indication and duration, review of therapy after the first days, selective restriction and prospective audit with feedback appear workable, while expensive tools depend on infrastructure that many hospitals lack. The evidence base is mostly uncontrolled before-and-after reporting from a small number of settings, with outcomes that are seldom comparable, and the risk of withholding needed treatment is rarely measured. The review concludes that stewardship is feasible in modest settings if it is built around local resources, and it lists what future reports should record.