Scoping review maps antimicrobial stewardship in LMIC tertiary hospitals

Antimicrobial stewardship programmes in tertiary hospitals across low- and middle-income countries show substantial variability in how they are designed and delivered, according to a scoping review published in Antimicrobial Resistance & Infection Control. The review, which followed the PRISMA-ScR guideline, identified 4,840 records and included 12 peer-reviewed primary studies conducted in tertiary hospitals within low- and middle-income countries that reported on stewardship implementation, interventions, outcomes, barriers or facilitators.

The synthesis, organised around a Population–Concept–Context framework, produced three major themes: the status and models of stewardship implementation, reported changes in antimicrobial use and prescribing practices, and the barriers, facilitators and strategies for sustaining stewardship programmes. The commonly reported approaches included educational interventions, prescribing audits, antimicrobial guidelines and multidisciplinary stewardship teams. Included studies reported improvements in selected antimicrobial prescribing practices following or alongside stewardship activities, although the review’s authors emphasise that implementation and outcomes varied considerably across settings.

The review’s conclusion is deliberately cautious: stewardship programmes may improve antimicrobial use and prescribing practices in these hospitals, but the available evidence is heterogeneous, and implementation remains strongly shaped by health-system and institutional factors. Because the evidence base consists of only 12 studies, the findings should be read as a map of what has been reported rather than a measure of effect size, and the review does not establish causal effectiveness for any single intervention model.

The barriers reported across the included studies were largely structural. Inadequate diagnostic capacity, workforce shortages, limited stewardship training, weak governance structures, poor surveillance systems and financial constraints were identified as key obstacles to implementing and sustaining stewardship in tertiary hospitals. These constraints reflect the broader context described in the review’s background, in which low- and middle-income countries carry high infectious disease burdens, operate with constrained healthcare resources and face challenges in antimicrobial governance, leaving them disproportionately affected by antimicrobial resistance.

Against those barriers, the review identified a consistent set of facilitators: leadership support, multidisciplinary collaboration, stewardship champions, institutional commitment and context-specific implementation strategies. The authors conclude that sustainable stewardship requires strengthening governance structures, workforce capacity, diagnostic infrastructure and organisational commitment, while adapting stewardship models to local healthcare contexts rather than importing them wholesale. The review was published on 7 October 2026 as an open-access article and is intended to consolidate a fragmented evidence base on how stewardship programmes are implemented, what outcomes they report, and where the evidence gaps lie in tertiary hospitals across low- and middle-income countries.

Subject of Research: Implementation, outcomes, barriers and facilitators of antimicrobial stewardship programmes in tertiary hospitals in low- and middle-income countries

Article Title: A scoping review of antimicrobial stewardship programmes in tertiary hospitals across low- and middle-income countries

Article References: Innocent, D. C., Anyakorah, P. E., Innocent, R. C., Anuwe, J. C., Innocent, I. P., & Gabson, D. J. (2026). A scoping review of antimicrobial stewardship programmes in tertiary hospitals across low- and middle-income countries. Antimicrobial Resistance & Infection Control. https://doi.org/10.1186/s13756-026-01827-3

Image Credits: AI Generated

DOI: 10.1186/s13756-026-01827-3

Keywords: antimicrobial resistance, antimicrobial stewardship, low- and middle-income countries, tertiary hospitals, scoping review, prescribing practices, health systems, infection control, diagnostic capacity, governance, scoping, review