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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Antibiotic stewardship: what for?

Carlos F Amábile-Cuevas1

  • 1Fundación Lusara, Mexico City, Mexico.

Frontiers in Antibiotics
|November 5, 2025
PubMed
Summary

Antibiotic stewardship is vital for patient safety and cost reduction, but its effectiveness against bacterial resistance needs reassessment. New strategies must address complex biological, environmental, and socioeconomic factors driving resistance.

Area of Science:

  • Microbiology
  • Public Health
  • Health Economics

Background:

  • Antibiotic stewardship programs (ASPs) and controlled antibiotic usage were traditionally primary defenses against bacterial resistance.
  • Recent studies indicate a disconnect between clinical antibiotic use and resistance patterns, suggesting other factors are more influential.

Purpose of the Study:

  • To reassess the role of antibiotic stewardship in controlling bacterial resistance.
  • To explore the influence of socioeconomic and environmental factors on antibiotic resistance patterns.
  • To propose a strategic shift for stewardship programs.

Main Methods:

  • Review of recent studies correlating antibiotic usage, resistance patterns, and various influencing factors.
  • Analysis of the interplay between biological, environmental, and socioeconomic determinants of antibiotic resistance.
Keywords:
antibiotic resistanceantibiotic stewardshipantibiotic usagehorizontal gene transfersocioeconomic factors

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Main Results:

  • Socioeconomic factors show stronger correlations with bacterial resistance than clinical antibiotic use.
  • Agricultural antibiotic use, urbanization, and mobile genetic elements are significant drivers of resistance.
  • The direct impact of stewardship on resistance patterns appears less pronounced than previously assumed.

Conclusions:

  • Antibiotic stewardship remains crucial for patient safety and cost reduction but requires a fundamental reassessment of its role in controlling bacterial resistance.
  • Future stewardship strategies should incorporate a broader understanding of resistance drivers, including non-clinical factors.
  • Developing comprehensive approaches that address the complex interplay of biological, environmental, and socioeconomic factors is essential for effective antibiotic resistance management.