Overview
Antimicrobial resistance (AMR) poses a critical threat to global health, and its impact is pronounced in the World Health Organization’s Eastern Mediterranean Region (EMRO). A recent scoping review synthesizes how antimicrobial stewardship (AMS) interventions have been designed, implemented, and evaluated across EMRO countries. The study maps clinical outcomes, economic implications, and patterns of antibiotic consumption, providing a clearer picture of what works in diverse health systems facing resource constraints, fragmented data, and varying regulatory environments.
AMR dynamics in EMRO are shaped by several factors, including infectious disease burden, antibiotic prescribing practices, access to medicines, and health system infrastructure. The scoping review highlights that AMS interventions—ranging from multifaceted programs to targeted stewardship activities—are increasingly adopted in tertiary hospitals, primary care settings, and public health institutions. The emphasis on evidence-informed strategies is critical for improving patient outcomes while curbing unnecessary antibiotic use.
Scope and Methods
The review canvassed a wide range of databases and study designs to capture the breadth of AMR stewardship work in EMRO. Researchers screened studies for interventions such as prospective audit and feedback, formulary restrictions, guideline implementation, dose optimization, rapid diagnostics, educational campaigns, and behavioral components. Inclusion criteria focused on interventions with measurable clinical, economic, or consumption outcomes, providing a multidimensional view of AMS effectiveness.
Because EMRO countries vary in language, health system maturity, and data availability, the scoping approach proved valuable for identifying both well-documented initiatives and emerging efforts in under-researched settings. Economic analyses—though less common—offer insight into cost savings from reduced antibiotic use, shorter hospital stays, and prevention of resistant infections, while consumption outcomes illuminate shifts in antibiotic prescribing and consumption patterns over time.
Clinical Outcomes
Clinical endpoints reported in EMRO AMS studies include reductions in inappropriate prescribing, shorter duration of antibiotic therapy, and sometimes decreases in treatment failures and adverse drug events. Several studies link stewardship activities to improved adherence to guidelines, enhanced antimicrobial dosing, and better diagnostic stewardship. In hospital settings, AMS programs that combine audit-and-feedback with education and decision support show promising improvements in prescribing quality and patient safety metrics.
Resistance patterns, while harder to measure in the short term, often respond to sustained stewardship efforts. When programs incorporate local guidelines tailored to regional resistance profiles, clinicians gain clearer paths to choose effective agents while avoiding broad-spectrum overuse. The review underscores the importance of local adaptation, ongoing surveillance, and feedback loops to sustain clinical gains.
Economic Outcomes
Economic assessments of AMS in EMRO are essential for policy decisions, particularly in low-resource environments. Reported outcomes include direct cost savings from reduced antibiotic purchases and decreased length of hospital stay, as well as indirect benefits such as fewer adverse events and lower rates of resistant infections. Cost-effectiveness analyses, where available, suggest that upfront investments in stewardship—staffing, education, and information systems—can yield long-term savings through more rational antibiotic use and improved clinical outcomes.
Barriers to economic gains frequently involve limited data on cost and outcomes, variability in healthcare financing, and the challenge of attributing cost savings directly to stewardship activities. Nevertheless, the studies emphasize that well-structured AMS programs can be financially justifiable, particularly when they align with national AMR action plans and procurement strategies that favor narrow-spectrum agents and guideline-concordant therapy.
Antibiotic Consumption Patterns
The scoping review highlights shifts in antibiotic use following stewardship interventions. Reductions in inappropriate prescriptions, inappropriate broad-spectrum use, and off-label dispensing are common targets. Some EMRO programs report more rational prescribing in outpatient settings and hospitals, alongside improvements in dosing accuracy and duration trimming. Importantly, successful interventions often couple clinician education with monitoring and feedback, reinforcing sustainable changes in prescribing culture.
Implications and Future Directions
For EMRO countries, the evidence base points to several best practices: building local stewardship teams, harmonizing guidelines with resistance data, investing in diagnostic capabilities, and ensuring ongoing training for frontline clinicians. Data infrastructure, robust surveillance, and standardized reporting will enhance cross-country learning and enable more precise economic evaluations. International collaboration and regional knowledge sharing can accelerate the adoption of effective AMS strategies suited to diverse health systems.
Conclusion
Antimicrobial stewardship interventions in the EMRO region show promise in improving clinical outcomes, achieving cost efficiencies, and stabilizing antibiotic consumption trends. While challenges remain—data gaps, financing, and implementation in varied settings—the scoping review offers a useful map for policymakers, health leaders, and clinicians aiming to strengthen antimicrobial stewardship and combat AMR across Eastern Mediterranean health systems.
