Antimicrobial stewardship

After first appearing in the medical literature in 1996,32 the term antimicrobial stewardship has become an increasingly popular idea to help contain AMR and sustain antibiotic effectiveness.

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Merriam-Webster defines stewardship as “the conducting, supervising, or managing of something; especially the careful and responsible management of something entrusted to one’s care.” Similar to environmental campaigns, which emphasize the earth’s limited natural resources and challenge us to live in a more environmentally friendly manner, antimicrobial stewardship campaigns challenge clinicians to be better stewards of our antimicrobial resources.

Antimicrobial stewardship encompasses a range of formal and informal approaches designed to conserve antibiotics, including educational programs, clinical guidelines, committees, and surveillance policies.33,34 Inpatient, outpatient and combined inpatient/outpatient antimicrobial stewardship campaigns do exist.

The CDC’s Get Smart campaign is considered one of the best examples of a combined inpatient/outpatient campaign35 and provides a wealth of evidence-based information and resources for patients and clinicians alike. In addition, antimicrobial stewardship campaigns have a small but growing body of research to support their effectiveness.34,36,37 For clinicians who choose not to join or start an antimicrobial stewardship group, committing to the 10 antibiotic prescribing principles is an excellent way to demonstrate antimicrobial stewardship.


Like water, soil and fossil fuels, antibiotics ought to be considered precious resources that require responsible management. If we are not vigilant about appropriate antibiotic prescribing now, a “postantibiotic era” will be inevitable.

NPs and PAs have a long history of providing safe, high-quality care. As experts in health care, NPs and PAs should assume a leading role in the antimicrobial stewardship campaign. At a minimum, NPs and PAs should consider adopting the aforementioned10 appropriate antibiotic prescribing principles.

Ann-Marie Hart, PhD, FNP-BC, is associate professor and coordinator of the Doctor of Nursing Practice program at the Fay W. Whitney School of Nursing, University of Wyoming, in Laramie.


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All electronic documents accessed October 15, 2011.