Antimicrobial stewardship programs in primary and secondary care settings in India: current challenges, facilitators, perceptions, and impact – a scoping review

This scoping review examined antimicrobial stewardship program (AMSP) practices in India’s primary and secondary healthcare settings following the 2015 WHO Global Action Plan. Out of 4,739 articles screened, only five met the criteria, highlighting the scarcity of evidence from resource-constrained regions. Reported barriers to AMSP implementation included limited healthcare access, weak regulatory enforcement, poor awareness of AMR and antibiotic policies, and inadequate provider knowledge. Identified facilitators included staff engagement, audit-and-feedback processes, administrative involvement, documentation, and educational activities. Only one study assessed both clinical and microbiological outcomes, showing improved prescribing, reduced antimicrobial use, shorter hospital stays, and lower mortality. Overall, the review underscores the urgent need for broader, tailored, and well-supported AMSP implementation across rural and underserved areas of India.