Hospital-Based Antimicrobial Stewardship Programs Used in Low and Middle-Income Countries: A Scoping Review

Setiawan, Eko and Aziz, Mohd-Hafiz Abdul and Roberts, Jason A. and Cotta, Menino Osbert (2022) Hospital-Based Antimicrobial Stewardship Programs Used in Low and Middle-Income Countries: A Scoping Review. Microbial Drug Resistance, 28 (5). pp. 566-584. ISSN 1931-8448

[thumbnail of MDR journal - Eko Setiawan-1.pdf] PDF
MDR journal - Eko Setiawan-1.pdf - Published Version
Restricted to Repository staff only

Download (48kB) | Request a copy
Official URL / DOI:


The burden of antimicrobial resistance (AMR) is considerable in many low- and middle-income countries (LMICs), and it is important to describe the antimicrobial stewardship program (ASP) activities found in these countries and report their impact. Importantly, as these programs target prescribing behavior, the factors influencing prescription of antimicrobials must also be taken into account. This scoping review aimed to (1) describe hospital-based ASP activities, (2) report methods used to measure the impact of ASPs, and (3) explore factors influencing antimicrobial prescribing behavior in LMICs. PubMed was searched from database incep- tion until April 2021. Factors influencing antimicrobial prescribing behavior were canvassed using the Capability- Opportunity-Motivation and Behavior framework. Most of ASP studies in LMICs were predominantly conducted in tertiary care and university-based hospitals. Audit of antimicrobial prescriptions with feedback and restrictive- based strategies was the main reported activity. Total antimicrobial consumption was the main method used to measure the impact of ASPs. Positive outcomes were observed for both clinical and microbiological outcomes; however, these were measured from nonrandomized controlled trials. Dominant factors identified through the behavioral framework were a limited awareness of AMR as a local problem, a perception that overprescription of antimicrobials had limited consequences and was mainly driven by a motivation to help improve patient outcomes. In addition, antimicrobial prescribing practices were largely influenced by existing hierarchy among prescribers. Our scoping review suggests that LMICs need to evaluate antimicrobial appropriateness as an added measure to assess impact. Furthermore, improvements in the access of microbiology and diagnostic facilities and ensuring ASP champions are recruited from senior prescribers will positively influence antimi- crobial prescribing behavior, helping improve stewardship of antimicrobials in these countries.

Item Type: Article
Uncontrolled Keywords: antimicrobial resistance, hospital settings, limited resource settings, stewardship program
Subjects: R Medicine > R Medicine (General)
R Medicine > RS Pharmacy and materia medica
Divisions: Faculty of Pharmacy > Department of Pharmacy
Depositing User: Eko Setiawan 206023
Date Deposited: 14 Jun 2022 10:15
Last Modified: 14 Jun 2022 10:15

Actions (login required)

View Item View Item