Antimicrobial stewardship refers to an organisational or healthcare-system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness.

Antimicrobial resistance may lead to standard treatments becoming ineffective, causing infections to persist and increasing the risk of them spreading. Although resistance evolves naturally, the use (and misuse) of antimicrobials speeds up this process. Inadequate infection prevention and control practices, poor sanitary conditions and inappropriate food handling encourage the spread of infections that may need the use of antibiotics.

Improvements in nutrition, hygiene and sanitation, and reductions in overcrowded housing, have all helped prevent and decrease the transmission of infectious diseases (Davies SC [2013] The drugs don't work. A global threat. London: Penguin). The World Health Organization estimates that, along with these broad environmental factors, antimicrobials add on average 20 years to life expectancy (Self-prescription of antibiotics boosts superbugs epidemic in the European region).

But antimicrobial resistance is increasing and there is a lack of new antimicrobials to treat resistant diseases. It is important to ensure the antimicrobials that are currently effective remain so for as long as possible.


Infectious diseases are a major cause of illness in the UK. In 2013, for example, 21% of all days lost at work (approximately 27 million days) were caused by coughs, colds and flu and other infectious diseases (Office for National Statistics' Sickness absence in the labour market: February 2014).

The incidence of infectious disease tends to be higher in groups with lower socioeconomic status and outcomes tend to be poorer. For example, they are more likely to have tuberculosis, transmit it to others and to have a drug-resistant strain (Department of Health's Annual report of the Chief Medical Officer 2011: volume 1).

Although viruses (such as HIV), parasites (such as malaria) and fungi (such as Candida) are showing resistance to antivirals, antiparasitics and antifungals respectively, for the general population antibiotic resistance is the main concern. However for some population subgroups, resistance to antivirals and antifungals may be of equal concern. This includes people who are particularly vulnerable to infection due to supressed immune systems; for example, because of HIV, an inherited condition or treatment they may be having for conditions such as cancer or an organ transplant.

In the UK, the spread of multidrug-resistant tuberculosis and gonorrhoea is also of public health concern (see the 'Annual report of the Chief Medical Officer 2011: volume 1').

Interventions and UK policy

National campaigns to raise public and professional awareness of antibiotic resistance may reduce antibiotic prescribing and demand (Department of Health's European antibiotic awareness day 2013 evaluation report). But a 2013 survey of 2,033 people in the UK by Ipsos MORI (Antibiotics: a cure for the common cold?) showed that:

  • 16% wrongly believe antibiotics work on colds or flu

  • around 40% think antibiotics can kill viruses

  • around 7% do not complete a course of antibiotics.

There is also evidence that most people who ask a healthcare professional for antibiotics to treat a cough are given them (Antibiotic prescribing for acute cough: the effect of perceived patient demand Coenen et al. 2006).

For details on UK policy, see the scope for this guideline.