Administrative interventions in antimicrobial stewardship: a global scoping review of all WHO regions

Although global antimicrobial resistance strategies increasingly emphasize multisectoral and systems-level responses, the role of administrative and governance-driven interventions within antimicrobial stewardship (AMS) remains relatively underexplored in the literature. Successful antimicrobial stewardship programs (ASPs) can only be achieved through multi-stakeholders' efforts, administration, and leadership at a multifaceted health system level, involving interventions that engage healthcare providers and patients and are supported by governance commitment and backed by financial support. The aim of this scoping review was to identify and map global evidence on administrative AMS interventions that shape ASPs. A systematic search of major databases (Google Scholar and PubMed) was conducted for studies published between January 2005 and June 2025. A total of 76 studies across all the World Health Organization (WHO) regions met the inclusion criteria and were included in the review. The included studies comprised observational studies, quasi-experimental studies, randomized control trials, and mixed-method studies. Data were extracted, mapped, and structured into six thematic categories pertaining to administrative AMS interventions: 1. health-system administrative governance, 2. community-centered administrative strategies, 3. prescription rationalization and dispensing regulation, 4. institutional accountability and premiums, 5. technology-driven education and capacity building, and 6. infection prevention measures. The findings of this study highlight the crucial role of governance-driven administrative interventions in strengthening antimicrobial stewardship and provide policy-relevant insights for augmenting administrative stewardship strategies globally.