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ROBERT C. OWENS JR., PHARM.D., is Co-Director, Antimicrobial Stewardship Program, Department of Pharmacy, and Clinical Pharmacy Specialist, Infectious Diseases, Division of Infectious Diseases, Maine Medical Center, Portland, ME. ANDREW F. SHORR, M.D., M.P.H., is Associate Director, Pulmonary Critical Care, Department of Medicine, Washington Hospital Center, Washington, DC. ANDREA L. DESCHAMBEAULT, PHARMD.,3 is Pharmacy Practice Resident, Department of Pharmacy, Maine Medical Center, Portland, ME.

Address correspondence to Dr. Owens at the Department of Pharmacy, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102-3175 (owensr{at}mmc.org).

Purpose. Differences in antimicrobial stewardship program (ASP) strategies, evidences supporting the benefits of ASPs, barriers to implementing ASPs, and suggestions for overcoming the barriers are discussed. Summary. Developing and implementing an ASP can facilitate more judicious use of antimicrobials. Prior authorization and prospective audit with feedback are two distinct methods of ASPs. Supplemental and combined strategies of ASPs also exist. Tangible benefits have been demonstrated with using ASPs, such as a reduction in antimicrobial consumption and reductions in costs. In addition, reduced use of certain antimicrobial agents has been correlated with reduction in antimicrobial resistance. Most importantly, ASP implementation may increase patient safety with minimization of antimicrobial-related medication errors such as unnecessary or duplicate antimicrobial use. However, barriers to ASP implementation exist such as acquiring funding for an ASP, a lack of pharmacy leadership supporting ASPs, a shortage of adequately trained infectious disease physicians and pharmacists, competition for funding with other programs in the hospital, and communicating with antagonizing colleagues. Conclusion. In the setting of increasing antimicrobial resistance, ASPs provide a formalized, practical, and manageable approach to improving the use of antimicrobials in our health care systems where their use is widespread and often suboptimal. Governmental agencies that require institutions to practice some form of antimicrobial stewardship can be the means to incentivize institutions to allocate resources for such programs. Index terms: Antiinfective agents; Costs; Economics; Errors, medication; Hospitals; Methodology; Protocols; Rational therapy; Resistance