Abstract
Antimicrobial resistance increases treatment failure, complications, mortality, and avoidable expenditure, particularly where diagnostic and stewardship capacity is limited. This narrative review examines how antimicrobial stewardship can translate policy into safer prescribing across primary, emergency, inpatient, and transition-of-care settings. Structured searches of biomedical databases, international repositories, and relevant national guidance informed a thematic synthesis of implementation barriers, core interventions, syndrome-based pathways, antibiotic classification, measurement, and discharge stewardship. Recurring barriers include unclear accountability, workforce and diagnostic constraints, weak information systems, prescribing norms, patient expectations, market pressures, and fragmented care. The review proposes a scalable package centred on syndrome-based prescribing, documentation of indication and duration, reassessment within 48–72 hours, intravenous-to-oral switching, selection aligned with the World Health Organization Access, Watch, and Reserve (AWaRe) framework, discharge review, and a small balanced set of antibiotic-use and safety indicators. These practical pathways and tools require local adaptation to epidemiology, resistance patterns, diagnostic capacity, regulation, and resources. Antimicrobial stewardship should be implemented as a patient-safety and quality-improvement strategy, with prospective evaluation of feasibility, clinical outcomes, and unintended consequences.