Antimicrobial stewardship implementation in Western Uganda: a narrative policy and implementation review

INTRODUCTION: Antimicrobial resistance (AMR) is a major health-system challenge in Uganda. Western Uganda has documented inappropriate antibiotic prescribing and local resistance patterns, but evidence on routine antimicrobial stewardship (AMS) implementation remains fragmented. AREAS COVERED: This structured narrative policy and implementation review synthesizes evidence on AMR and antimicrobial stewardship (AMS) implementation in Western Uganda, drawing on Western Uganda-specific studies, Uganda-wide evidence, national policy documents, and broader low- and middle-income country implementation literature. Evidence was identified through targeted PubMed searches, World Health Organization resources, and Ugandan Ministry of Health repositories focused on AMR, AMS, antibiotic use, diagnostics, surveillance, community pharmacies, drug shops, One Health, and low-resource settings. EXPERT OPINION: The strongest immediate case for stewardship in Western Uganda is supported by local prescribing studies, national hospital point-prevalence data, and Uganda's current policy framework. A feasible minimum package should combine named facility responsibility, Uganda Clinical Guideline and AWaRe-informed prescribing support, small-sample prescription review, laboratory referral and feedback, private pharmacy engagement, and district supervision. The phased framework proposed in this review is an author-developed implementation synthesis; it has not yet been adopted or evaluated.