Antimicrobial Stewardship

Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.


The use of antimicrobials is the single most important factor leading to antimicrobial resistance around the world. The Centers for Disease Control and Prevention (CDC) estimates, more than 2.8 million people are infected with antibiotic-resistant organisms and approximately 35,000 of these infections result in death in the United States annually.

In U.S. acute care hospitals, it is estimated that 20-50% of all antibiotics prescribed are either unnecessary or inappropriate. Through the promotion of evidence-based antibiotic stewardship programs we can improve individual patient outcomes, reduce overall burden of antibiotic resistance, and decrease healthcare costs. 

AS Team

The AS Team at Texas’ Department of State Health Services (DSHS) promotes interventions to measure and improve antimicrobial use through the CDC’s “five D’s” and Core Elements of AS.

5 D’s of AS:

  1. Diagnosis: the patient’s diagnosis requires antibiotic therapy
  2. Drug choice: the drug treats the organism that is present
  3. Dose: the recommended dose is within the correct range
  4. Duration of therapy: appropriate medication period  
  5. De-escalation: the organism is no longer present and drug therapy can be reduced or stopped, preventing excess antibiotic therapy

Website: NIH Antimicrobial Stewardship

CDC’s Core Elements of AS:

  1. Leadership commitment: Dedicating resources
  2. Accountability: Single leader
  3. Drug expertise: Single pharmacist leader
  4. Action: Implementing at least one recommended action
  5. Tracking: Monitoring antimicrobial prescribing and resistance patterns
  6. Reporting: Regular AR and antimicrobial use reporting
  7. Education: Informing clinicians about resistance, optimal prescribing

Website: Core Elements of Antibiotic Stewardship

Our Projects

Advisory Committees

Application submission period for the Antimicrobial Stewardship Regional Advisory Committees Public Health Region 1 has been reopened for the Director of Nursing position. If you are interested, please apply by emailing

U.S. Antibiotic Stewardship Awareness Week

November 18-24, 2023

Join Texas DSHS Antibiotic Stewardship Program in supporting the CDC’s observance of the U.S. Antibiotic Awareness Week (USAAW) - November 18-24, 2023. This week-long observance highlights the steps everyone can take to improve antibiotic prescribing and use.

Annual Report

2022 Annual Report: The AS Team at DSHS has released a report documenting the progress of our newly formed team in 2022.

Other AS Projects:

  1. Antimicrobial Use Assessments: The AS team performs voluntary, free, and non-regulatory assessments for healthcare facilities looking to improve their antimicrobial use.
  2. Annual Webinar: AS related topics are presented at an annual training for healthcare professionals. This past year’s webinar is outlined in our Annual Report. 2024 webinar topic coming soon.
  3. Collaborations: The AS team is open to collaborations from our academic partners, regional and local health departments, and healthcare facilities. Current collaborations include UT Dell Medical School, Austin Public Health, and the Houston Health Department.

For more information contact:

Antimicrobial Stewardship Team at DSHS:
Phone: (737) 256-8105