A recent global scoping review has underscored the critical role of administrative interventions in strengthening antimicrobial stewardship (AMS) programs worldwide. Published in Frontiers in Pharmacology, the review identifies six key administrative categories that shape health system responses to antimicrobial resistance (AMR), a significant global public health challenge.
Addressing Antimicrobial Resistance Through Governance
Antimicrobial resistance represents a major threat, contributing to over 1.2 million deaths annually, according to Murray et al. (2022), as cited in the review. The World Health Organization (WHO) has designated AMR as one of the top ten global health threats. Projections suggest that if current trends persist, AMR could directly cause 1.9 million deaths and contribute to a total of 8.2 million deaths globally by 2050, with an estimated annual economic burden of US$100 trillion (O’neill, 2014, as cited in the source). The global antibiotic consumption rate increased by 46% between 2000 and 2018, from 9.8 defined daily doses (DDDs) per 1,000 population per day to 14.3 DDDs per 1,000 per day (Browne et al., 2021, as cited in the source).
While many existing AMS interventions focus on clinical tools and individual healthcare providers, the review by Ali Uzair et al. shifts focus to the administrative and leadership domains. It highlights that successful AMS programs require multifaceted efforts from various stakeholders, supported by effective leadership, governance commitment, and financial backing at a health system level.
Administrative Interventions in Antimicrobial Stewardship
The scoping review systematically searched major databases for studies published between January 2005 and June 2025, identifying 76 studies across all WHO regions that met the inclusion criteria. These studies comprised observational, quasi-experimental, randomized controlled trials, and mixed-method designs. The extracted data were mapped and structured into six thematic categories of administrative AMS interventions:
- Health-system administrative governance: Encompassing policy decisions, institutional mandates, and leadership actions that enable or constrain AMS efforts.
- Community-centered administrative strategies: Interventions focused on engaging communities and patients in judicious antimicrobial consumption.
- Prescription rationalization and dispensing regulation: Administrative controls and policies governing the appropriate prescribing and dispensing of antimicrobials.
- Institutional accountability and premiums: Frameworks for ensuring responsibility and providing incentives within healthcare institutions for AMS adherence.
- Technology-driven education and capacity building: Utilizing technological solutions for continuous training and education for providers and patients.
- Infection prevention measures: Administrative support and implementation of strategies to prevent infections, thereby reducing the need for antimicrobials.
The authors note that while some identified interventions may have a direct clinical or educational function, they were classified as administrative AMS strategies when their implementation, scaling, or sustainability was enabled by policy decisions, institutional mandates, or governance-level actions. This categorization emphasizes the system-level implementation pathways and the role of administrative enablement.
Policy Implications for Global Health Systems
The findings provide insights for policymakers aiming to develop system-wide reforms to establish and strengthen administrative antimicrobial stewardship. The review suggests that by systematically structuring global evidence, it demonstrates how administration- and leadership-enabled health system governance, institutional accountability, and community-centered strategies collectively influence stewardship outcomes. This approach moves beyond individual clinical interventions to consider the broader organizational and policy environment necessary for effective AMR control.
The World Health Assembly’s Global Action Plan on Antimicrobial Resistance (2015), as cited in the source, identified judicious use of antibiotics as a key goal. The review reinforces the need for impactful health system-level interventions, including strong antimicrobial leadership, continuous training, enforcement of guidelines, regular feedback on antibiotic use, transparent reporting, and clear accountability frameworks.
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