An integrated antimicrobial stewardship approach in tertiary care hospitals in developing countries using a multidomain framework ("PRESCRIBES'' checkpoint): A call for action

Antimicrobial resistance (AMR) remains a critical global health threat, especially in low- and middle-income countries (LMICs). The Society of Antimicrobial Stewardship PractIces (SASPI) in India recently published 42 Integrated Antimicrobial Stewardship (IAS) Practice Statements- a unified framework spanning administrative, diagnostic, infection-prevention, and antimicrobial-use domains These statements translate national and global AMR strategies into actionable checkpoints suitable for hospitals in LMICs like India. Unlike conventional siloed models, IAS promotes coordinated accountability between hospital leadership, diagnostic laboratories, and prescribers. This editorial summarizes rationale, structure, and operational value of the 42 stewardship practices through a "PRESCRIBES" framework in the form of checkpoints and highlights its relevance to LMICs. It is the right moment to initiate these checkpoints organized under the following subheadings 1) Policy for AMR containment, 2) Resource integration for IAS practice, 3) Education to different cadres of healthcare providers, 4) Surveillance of practices, 5) right Culture of sending and acting upon diagnostics, 6) Rational antimicrobial use, 7) Information updates through AMR dashboards, 8) attention to right Behavioral interventions driving appropriate practices, 9) Engagement with multiple sections and cadres, and10) Sustainability plans and actions With regular audits of facilities against "PRESCRIBES'' framework, we think a culture of self-evaluation by healthcare facilities can be fostered. Additionally, the periodic exchanges of experiences such as that done during National Conference of SASPI, a platform can be provided for learning and sharing of useful practices. Embedding such integrated frameworks is essential to achieve the targets of National Action Plan on AMR and the WHO Global Action Plan.