Antimicrobial Stewardship in Low- and Middle-Income Countries

  • Juan Ignacio Dapás
  • Rodolfo E. Quirós
Infection Prevention and Safety in Low and Middle Income Countries (C Bardossy, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Infection Prevention and Safety in Low and Middle Income Countries


Purpose of review

Antimicrobial stewardship (AMS) is one of the core elements of infection prevention and control, but in many resource-limited countries its implementation is absent or suboptimal. There is inadequate information on the best model for an AMS program. AMS should be adapted to each region according to sociocultural dimensions, financing, and antimicrobial resistance.

Recent findings

Many of antimicrobials prescribed in hospitals are inappropriate or unnecessary, increasing the risk of adverse reactions and antimicrobial resistance. AMS programs are of essential benefits in low- and middle-income countries (LMIC) where high level of antimicrobial resistance is reported. Low-quality and/or counterfeit antimicrobials and self-medication are known problems in LMIC opposing to adequate AMS programs.


AMS programs must be present in all scenarios and should be context- and culture-adapted, balancing effectiveness and cost of different strategies. Analysis of AMS programs should be done at each institution of the country and its health system. Diagnostic algorithms and treatment guidelines should be readily available and should be context adapted based on local epidemiology and bacterial resistance. Multidisciplinary groups should be created to improve AMS in each region, including human health, veterinary, and agriculture.


Antimicrobial stewardship Low- and middle-income countries Emerging economies Antimicrobial resistance Infection prevention and control Patient safety 


Compliance with ethical standards

Conflict of interest

Dr. Dapás declares that he has no conflict of interest.

Dr. Quirós has received personal fees from 3M Company, GSK, and MSD.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. 1.Infectious Diseases DivisionHospital Italiano de MendozaMendozaArgentina
  2. 2.Infectious Diseases DivisionHospital Central de MendozaMendozaArgentina
  3. 3.Gerente General, Clínica Ángel FoianiniSanta Cruz de la SierraBolivia

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