Antimicrobial Stewardship

Antimicrobial stewardship programs are coordinated programs within a health care setting that promote the appropriate use of antimicrobials, thereby improving patient outcomes, reducing antibiotic resistance, and decreasing the spread of infections caused by antibiotic-resistant organisms.

AHRQ's work on antimicrobial stewardship programs is part of the broad national effort to maintain the effectiveness and safety of the Nation’s antibiotics. They are an important part of the White House’s National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB).

AHRQ has developed tools, research, and resources to improve the use of antibiotics through antimicrobial stewardship programs.

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Nursing Home Antimicrobial Stewardship Guide

AHRQ's Nursing Home Antimicrobial Stewardship Guide is a research-based resource that offers materials to help nursing homes improve antibiotic use and decrease harms caused by inappropriate prescribing. The guide is customizable to meet facilities' needs and includes four toolkits:

Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship

This toolkit assists hospital staff and leadership in developing an effective antimicrobial stewardship program with the potential to reduce Clostridium difficile (C. difficile).



Effectiveness of an Antimicrobial Stewardship Approach for Urinary Catheter-Associated Asymptomatic Bacteriuria. This study shows that a multifaceted intervention targeting health care professionals who diagnose and treat patients with urinary catheters reduced overtreatment of asymptomatic bacteriuria compared with standard quality improvement methods. The impact was more pronounced in long-term care.

Developing Capacity to Implement Antimicrobial Stewardship: Opportunities for the Future. This study found that using limited case-control methods for antibiotic selection was a feasible, practical, and acceptable approach for facilities to identify potential antibiotic targets for antimicrobial stewardship programs.

Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies: Volume 4—Antibiotic Prescribing Behavior. This report concludes that quality improvement efforts appear generally effective at reducing both inappropriate treatment with antibiotics and inappropriate selection of antibiotics. While no single quality improvement strategy was more effective than others, active clinician education may be more effective than passive education, particularly for addressing the antibiotic treatment decision.

Antimicrobial stewardship: another focus for patient safety? This review summarizes the literature on antimicrobial stewardship to illustrate its relationship with patient safety. Interventions to reduce unnecessary antibiotic use included guidelines for controlling Clostridium difficile infection rates, mandatory outpatient parenteral therapy consultations, and performing medication reconciliation.


AHRQ's Innovations Exchange features several innovations on antimicrobial stewardship.

Ongoing Projects

AHRQ Safety Program for Improving Antibiotic Use

This project aims to help clinicians in hospitals, doctors' offices, and long-term care apply the Comprehensive Unit-based Safety Program (CUSP) method to improve antibiotic stewardship by selecting the optimal antibiotic regimens, routes of administration, and durations. Tools, resources, and lessons learned by the facilities that are participating in this 5-year project will be compiled into a toolkit, allowing other facilities to improve antibiotic stewardship.

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