Physician barriers to implementation of hospital-based antimicrobial stewardship programs (ASPs): a global perspective

  • Linda M. KaljeeEmail author
  • Tyler Prentiss
  • Marcus Zervos
Infection Prevention and Safety in Low and Middle Income Countries (AC 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 resistance (AMR) is a significant global health issue. Hospital-based antimicrobial stewardship programs (ASPs) are an important component of a “One Health” approach for addressing AMR. However, the adaptation and implementation of ASPs in low-resource settings often faces multiple barriers, which need to be identified and addressed to ensure program effectiveness.

Recent findings

Barriers to ASPs adoption have been identified at the health system and hospital levels, within the organization and interpersonal relationships in wards and departments, and at the individual level of knowledge and perceptions of physicians and other health providers regarding AMR and antimicrobial prescribing practices. Utilizing the Consolidated Framework for Implementation Research (CFIR) is one means of providing a model for adapting ASPs to meet local needs and for recognizing and addressing barriers prior to and during program implementation.


Despite challenges, hospital-based ASPs have been successfully introduced in low-resource settings. Key components of successful ASPs include a focus on de-escalation, development of local prescribing guidelines, inclusion of non-medical training such as communication, and engagement and partnering with a broad coalition of institutional and organizational stakeholders throughout the adaptation, evaluation, implementation, and scale-up processes.


Antimicrobial stewardship Barriers Hospital-based Global 


Compliance with ethical standards

Conflict of Interest

Linda Kaljee, Tyler Prentiss, and Marcus Zervos declare that they have no conflict of interest.

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

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Linda M. Kaljee
    • 1
    Email author
  • Tyler Prentiss
    • 1
  • Marcus Zervos
    • 2
  1. 1.Henry Ford Health SystemGlobal Health InitiativeDetroitUSA
  2. 2.Henry Ford Health SystemDivision of Infectious DiseaseDetroitUSA

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