Barriers and Facilitators to Antimicrobial Stewardship Implementation Across Healthcare Settings in Bangladesh: A Systematic Review

Why It Matters

Without robust AMS, Bangladesh risks accelerating AMR mortality and undermining global health security, making immediate systemic reforms critical.

Key Takeaways

• Policy enforcement gaps stall AMS program rollout
• Empirical prescribing dominates due to diagnostic shortages
• Surveillance and training act as primary facilitators
• Culture‑guided prescriptions under 35% of cases
• Multidisciplinary teams essential for sustainable stewardship

Pulse Analysis

Antimicrobial resistance is a global health emergency, accounting for 1.27 million deaths each year and projected to rise sharply by 2050. Bangladesh, a densely populated lower‑middle‑income country, reported 26,200 AMR‑related fatalities in 2019, highlighting a stark mismatch between its ambitious National Action Plan and on‑the‑ground clinical practice. Effective antimicrobial stewardship (AMS) is widely recognized as the cornerstone for curbing unnecessary antibiotic use, yet the country's health system grapples with limited resources, fragmented governance, and a cultural reliance on empirical therapy. Understanding these systemic gaps is essential for aligning national policy with measurable outcomes.

The systematic review published in 2025 synthesized fourteen studies involving 34,097 participants, revealing that AMS initiatives in Bangladesh remain largely fragmented. Only 31 % of prescriptions were guided by microbiological culture, while more than 70 % of hospitalized patients received broad‑spectrum agents. The most frequently cited barriers were absent or weakly enforced hospital policies, a entrenched culture of empirical prescribing, insufficient laboratory capacity, and the lack of dedicated AMS teams. Conversely, functional surveillance systems, targeted training programs, and strong leadership commitment emerged as the primary facilitators that can accelerate stewardship adoption.

Translating Bangladesh’s National Action Plan into tangible clinical impact will require coordinated investment in diagnostic infrastructure, real‑time surveillance, and regulatory enforcement. Establishing multidisciplinary AMS committees, integrating audit‑and‑feedback loops, and enforcing formulary controls can shift prescribing behavior from empiric to evidence‑based. International donors and private sector partners can play a catalytic role by funding laboratory upgrades and capacity‑building workshops, while the Ministry of Health must institutionalize accountability mechanisms. If these systemic levers are activated, Bangladesh could reduce unnecessary broad‑spectrum use, improve patient outcomes, and contribute to global efforts to contain AMR.