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Core Elements of Antimicrobial Stewardship

Core Elements of Antimicrobial Stewardship

The Centers for Disease Control and Prevention's (CDC) Core Elements of Antibiotic Stewardship offer providers and facilities a set of seven key principles to guide efforts to improve antibiotic use and, therefore, advance patient safety and improve outcomes:

  • Leadership commitment: Dedicating necessary human, financial, and information technology resources.
  • Accountability: Appointing a single leader responsible for program outcomes. The 2019 update highlights the effectiveness of the physician and pharmacy co-leadership.
  • Pharmacy expertise (previously "Drug Expertise"): Appoint a pharmacist, ideally as the co-leader of the stewardship program, to lead implementation efforts to improve antibiotic use.
  • Action: Implement interventions, such as prospective audit and feedback or preauthorization, to improve antibiotic use.
  • Tracking: Monitor antibiotic prescribing, impact of interventions, and other important outcomes like C. difficile infection and resistance patterns.
  • Reporting: Regularly report information on antibiotic use and resistance to prescribers, pharmacists, nurses, and hospital leadership.
  • Education: Educate prescribers, pharmacists, and nurses about adverse reactions from antibiotics, antibiotic resistance and optimal prescribing.

CDC's Core Elements of Antibiotic Stewardship

Percentage of Hospitals Meeting all 7 Core Elements of Hospital ASPs by State, 2018

The (seven) Core Elements by setting:

Hospital Antibiotic Stewardship Programs

Small and Critical Access Hospitals


Nursing Homes

Resource-Limited Settings