Antibiotic Stewardship in the Austere Environment: A Narrative Review

Authors

Andrew H. Chaney, University of LynchburgFollow

Specialty

Antibiotic Stewardship in the Austere Environment

Advisor

Dr. Thomas Colleti

Abstract

Antibiotic stewardship is a critical concern for all clinicians across all practice settings, including remote and austere environments. These settings present unique challenges such as extreme weather patterns due to climate change, resource scarcity, and logistical barriers including delayed resupply, limited climate control for medications, and restricted transportation options. As global conflict and environmental instability rise, more clinicians may find themselves practicing in these constrained environments.

This clinical review examines current antibiotic stewardship strategies in resource-constrained settings, recent advances in dynamic operational environments, and potential new directions for further research to investigate. Although antibiotic resistance was first described in the 1940s, dedicated clinical education covering antibiotic stewardship remains a mainstay of risk mitigation. A narrative review of over 50 studies focused on antibiotic stewardship in the remote primary care setting found that the risk of inappropriate prescribing was substantially higher than that in more urbanized areas.

Core opportunities include more robust institutional policies, surveillance, and decision support tools. Emerging interventions such as infectious disease telehealth consultations, novel antibiotic administration strategies, and abbreviated courses of antibiotics, have shown promise in reducing resistance risk. By adopting a robust yet streamlined antibiotic stewardship approach, remote clinicians can optimize available resources while mitigating risk to their patients.

Recommended Citation

Chaney AH. Antibiotic Stewardship in the Austere Environment: A Narrative Review. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2025; 7(3).