Systematic review of clinical outcomes from the implementation of hospital-based antimicrobial stewardship programs in India

Antimicrobial resistance (AMR) is a growing concern that can compromise clinical outcomes as well as increase the significant economic stress on healthcare systems. Antimicrobial stewardship programs (ASPs) have demonstrated promising results in improving treatment outcomes and reducing costs worldwide. However, the effectiveness of ASP in Indian hospital settings remains underexplored. This systematic review aimed to evaluate the effectiveness of implementing ASP in Indian hospital settings. Literature search was carried out in electronic databases such as PubMed, Clinical Trials Registry-India, Clinicaltrials.gov, and Google Scholar from January 2015 till April 2025 to identify published studies that explored the clinical outcomes in Indian hospital-based settings that implemented ASP. Studies that assessed at least one of the following outcomes-AMR pattern, infection rate, mortality rate, prescription pattern, costs, or barriers/challenges in ASP implementation-were eligible for screening. Two independent reviewers screened the articles for eligibility, with discrepancies resolved through discussion with a third reviewer. Out of the 1732 studies screened, 11 studies were found eligible for inclusion. Those studies were conducted in different Indian states. Each study implemented different ASP practices, including infection control, audit and feedback, and customized training. Most of the studies evaluated demonstrated improvements such as a reduction in inappropriate prescriptions, lower antimicrobial resistance rates, decreased infection and mortality rates, and reduced costs following the implementation of ASP. Despite the benefits, implementation challenges remain. This review highlights the need for strict ASP implementation and monitoring in Indian hospitals to combat AMR.