title: Antibiotic stewardship: overcoming implementation barriers.
abstract: OBJECTIVE
  Antimicrobial stewardship is now recognized as a formal strategy for curbing the upward trend in antibiotic resistance. Literature on antimicrobial stewardship has focused on areas of strategic importance and operational delivery. A number of barriers have been recognized in the implementation of successful programs. These include lack of physician participation, lack of diagnostic facility, absence of formal mechanism of data collection, variation between countries, and lack of cooperative strategies. In this review, we suggest strategies to overcome these barriers.
  
  
  RESULTS
  In the last few years, it has been recognized that an executive program is necessary for successful implementation of strategies to control the growing antibiotic resistance. Efforts have been made at higher levels of government through organizations such as the European Centre for Disease Prevention and Control. The need for community healthcare involvement has also been recognized. At a local level, strategies to promote cooperation between various committees (e.g. infection control and antimicrobial management teams) have been proposed and adopting antibiotic care bundles as part of patient safety and healthcare is being explored.
  
  
  CONCLUSIONS
  We suggest that executive level planning, local cooperation, sustained education, emphasis on de-escalation, and use of care bundles could stem the tide of growing resistance.
authors.affiliation: Department of Medical Microbiology, Crosshouse Hospital, NHS Ayrshire and Arran, UK.
authors.forename: Abhijit M
authors.initials: AM
authors.lastname: Bal
authors.forename: Ian M
authors.initials: IM
authors.lastname: Gould
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002985:Clinical Protocols; D003695:Delivery of Health Care; D004352:Drug Resistance, Microbial; D057970:Inappropriate Prescribing; D017053:Infection Control
chemical_list: D000900:Anti-Bacterial Agents