Challenges and Strategies for Implementing Antimicrobial Stewardship Programs in India: Insights from Multiple Stakeholders

Background: Hospitals routinely practise Antimicrobial Stewardship (AMS) to prevent antibiotic resistance and ensure medication safety. However, rising antibiotic resistance casts concern on AMS's usefulness. This study examines the main challenges to AMS program implementation from the perspectives of healthcare professionals, pharmacists, and the public. Materials and Methods: Mixed-methodologies research used quantitative and qualitative methods. In-depth simulated interviews were done with 90 participants (30 healthcare professionals, 30 pharmacist, and 30 general public members) in three antibiotic-free scenarios: non-bloody loose stool, common cold and cough, and direct antibiotic requests. The interviews were performed in two phases: a blinded phase for unbiased assessment and a follow-up phase to explore factors influencing AMS. It was registered with the Clinical Trials Registry of India (CTRI/2024/02/062204). Results: Irrational use of antibiotics was prevalent with 73.33% of physicians, 93.33% of pharmacists, and 100% of the general public. Thematic analysis identified several barriers to AMS implementation. From the physician’s perspective, key challenges included adherence to guidelines, patient expectations and pressure, time constraints, and patient’s reluctance to undergo diagnostic testing. Pharmacists highlighted patient preferences for specific antimicrobials, financial constraints, facility-level factors affecting dispensing, and inadequate monitoring and feedback mechanisms. For the general public, barriers included a lack of awareness, misconceptions about antibiotics, the influence of online information, and financial limitations. Conclusion: To overcome these obstacles, specific interventions are necessary, including the implementation of pharmacist-led patient education initiatives, the establishment of definitive procedures for diagnostic testing, and the assurance of sustainable financial frameworks. Comprehensive, evidence-based, and multi-stakeholder strategies are essential for optimising AMS adoption and addressing antimicrobial resistance.