[Principles of antimicrobial stewardship]

The global emergence of multiresistant pathogens threatens the effectiveness of antimicrobial therapies and calls for a rational use of antibiotics, antivirals, and antifungals. The main reason for the development of resistance is the inappropriate use of these substances in human and veterinary medicine and agriculture. Antimicrobial stewardship (AMS) combines strategies for optimizing prescribing practices in order to prevent the development of resistance, ensure successful treatment, and minimize side effects. Central elements are evidence-based guidelines, interdisciplinary visits, infectious disease consults, targeted training, feedback systems, and digital support. AMS is becoming increasingly established in Germany, but many antibiotics are still not prescribed in line with guidelines. Correct diagnosis, guideline-based empirical therapy, regular re-evaluation, dose adjustment, early oral administration, and outpatient parenteral anti-infective therapy (OPAT) are essential. Short, individually adapted treatment durations improve tolerability and reduce resistance pressure. AMS links epidemiological data with patient-specific factors and is key in personalized infection medicine. Only the consistent integration of AMS measures into everyday clinical practice can ensure the sustained efficacy of antimicrobial substances and improve the quality of patient care in the long term.