Core Elements of Hospital Antibiotic Stewardship Programs

Hospital antibiotic stewardship programs are essential to optimize patient care and help combat antimicrobial resistance. The Core Elements of Hospital Antibiotic Stewardship Programs, 2019 [PDF – 40 pages] outline structural and procedural components that are associated with successful antibiotic stewardship programs.
The antibiotic stewardship program assessment tool (Print Only) [PDF – 8 pages] is a companion to Core Elements of Hospital Antibiotic Stewardship Programs. This tool provides examples of ways to implement the Core Elements.


Antibiotics have transformed the practice of medicine, making once lethal infections readily treatable and making other medical advances, like cancer chemotherapy and organ transplants, possible. Prompt initiation of antibiotics to treat infections reduces morbidity and save lives, for example, in cases of sepsis (1). However, about 30% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or suboptimal (23).

Like all medications, antibiotics have serious adverse effects, which occur in roughly 20% of hospitalized patients who receive them (4). Patients who are unnecessarily exposed to antibiotics are placed at risk for these adverse events with no benefit. The misuse of antibiotics has also contributed to antibiotic resistance, a serious threat to public health (5). The misuse of antibiotics can adversely impact the health of patients who are not even exposed to them through the spread of resistant organisms and Clostridioides difficile (C. difficile) (6).

Optimizing the use of antibiotics is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance. Antibiotic Stewardship Programs (ASPs) can help clinicians improve clinical outcomes and minimize harms by improving antibiotic prescribing (27). Hospital antibiotic stewardship programs can increase infection cure rates while reducing (7-9):

For More Information

In Antibiotic Resistance Threats in the United States, 2019, CDC estimates that more than 2.8 million antibiotic-resistant infections occur in the United States each year, and more than 35,000 people die as a result.

  • Treatment failures
  • C. difficile infections
  • Adverse effects
  • Antibiotic resistance
  • Hospital costs and lengths of stay

In 2014, CDC called on all hospitals in the United States to implement antibiotic stewardship programs and released the Core Elements of Hospital Antibiotic Stewardship Programs (Core Elements) to help hospitals achieve this goal. The Core Elements outlines structural and procedural components that are associated with successful stewardship programs.

In 2015, The United States National Action Plan for Combating Antibiotic Resistant Bacteria set a goal for implementation of the Core Elements in all hospitals that receive federal funding (10).