Antibiotic steward

An antibiotic steward, also known as an antimicrobial steward, is a healthcare professional actively involved in antimicrobial stewardship (AMS) programmes aimed at optimising antimicrobial use to combat antimicrobial resistance (AMR) and improve patient outcomes NICE NG15 Schrier et al. 2018. These individuals often hold formal roles or responsibilities dedicated to AMS within healthcare organisations and may include physicians, pharmacists, medical microbiologists, nurses, and community health workers depending on the care setting NICE NG15 Castro-Sánchez et al. 2025 Hirsch et al. 2026.

Roles and responsibilities of an antibiotic steward encompass diverse activities focused on ensuring the judicious use of antimicrobials and supporting patient safety, aligned with national and local guidelines. This includes monitoring and evaluating antimicrobial prescribing patterns, benchmarking individual prescriber behaviour against local and national data, and relating prescribing to local resistance trends and patient safety incidents such as infections with Clostridium difficile or adverse drug reactions NICE NG15.

They provide education and continuous training to health and social care practitioners on AMS principles and antimicrobial resistance, integrating audit into quality improvement programmes and developing processes for regular feedback to prescribers across all care settings NICE NG15 Schrier et al. 2018. They further assist local formulary decision-making and update prescribing guidelines to reflect evidence and resistance patterns NICE NG15.

Antibiotic stewards also conduct stewardship interventions such as prescribing reviews to identify unusual prescribing volumes or use of non-recommended antimicrobials, promoting antimicrobial choices aligned with guidelines, and providing direct feedback or advice to prescribers when antimicrobial use is unjustified NICE NG15. Decision support systems and IT tools may be developed or utilised by stewards to aid prescribers in decisions about when or whether to prescribe antimicrobials, including approaches like delayed prescribing NICE NG15.

In addition to organisational responsibilities, stewards foster a culture of open peer review and accountability among prescribers, encouraging consistent communication, sharing of learning on antimicrobial use and resistance, and senior professional leadership in stewardship practices NICE NG15. Laboratory testing coordination, such as ordering microbiological samples before antimicrobial initiation and reporting susceptibility results aligned with guidelines, is supported by stewards NICE NG15.

Community health workers (CHWs) are increasingly recognised as valuable antibiotic stewards in primary and community care, especially in low- and middle-income countries. They engage in prevention strategies such as health education, vaccination campaigns, infection prevention measures, and promotion of appropriate antibiotic use, contributing directly to reducing infections and antibiotic misuse Castro-Sánchez et al. 2025. CHWs also participate in detection by assessing symptoms, classifying diseases, performing point-of-care tests, and managing treatments including authorised antibiotic prescribing and dispensing Castro-Sánchez et al. 2025. However, their involvement varies by training, local policies, and healthcare system integration Castro-Sánchez et al. 2025.

Training and ongoing support are essential components of effective stewardship roles, with pharmacists often receiving postgraduate infectious diseases and AMS-specific training, enabling them to deliver advanced stewardship activities including prospective audit, feedback, and educational roles within healthcare systems PubMed. Likewise, tailored competency-based training enhances CHWs’ stewardship effectiveness Castro-Sánchez et al. 2025 Schrier et al. 2018.

In summary, antibiotic stewards hold accountable and clearly defined roles within AMS programmes encompassing monitoring, education, guideline development, prescribing review, feedback provision, and fostering stewardship culture across all health care settings, including roles for pharmacists, medical microbiologists, and expanding to community health workers. Their functions aim to promote safe, effective, and judicious antimicrobial use aligned with local and national standards to preserve antimicrobial efficacy and improve patient safety NICE NG15 Castro-Sánchez et al. 2025 Hirsch et al. 2026.