Antimicrobial Stewardship Programs in Chile: A Historical Overview

Antimicrobial Stewardship Programs (ASPs) are a cornerstone strategy to mitigate the global threat of antimicrobial resistance (AMR), primarily driven by inappropriate antimicrobial use. ASPs aim to optimize antimicrobial therapy by ensuring appropriate indication, agent selection, dosing, route of administration, and duration of treatment. Through these interventions, ASPs improve clinical outcomes, reduce adverse drug events, decrease selective pressure for resistant organisms, and contribute to healthcare cost containment. Effective implementation requires a multidisciplinary approach involving physicians, pharmacists, microbiologists, nurses, and information technology specialists, and must be tailored to local epidemiology and healthcare system capacity in accordance with World Health Organization (WHO) recommendations. This narrative review describes the development and evolution of the national antimicrobial stewardship policy in Chile, based on a review of publications indexed in SciELO, official documents from the Ministry of Health (MINSAL), and relevant national legislation. In Chile, antimicrobial stewardship initiatives began in the late 1990s with regulatory measures mandating prescription-only dispensing of antimicrobials and the introduction of national technical standards for rational antimicrobial use. After that, Chile adopted a comprehensive One Health approach and implemented national AMR action plans aligned with WHO strategies. Substantial progress has been achieved across hospital, primary care, veterinary, and aquaculture settings, including expanded ASP coverage, strengthened regulatory frameworks, national surveillance systems for antimicrobial consumption and resistance, and incorporation of stewardship indicators into institutional performance metrics. Despite these advances, challenges related to workforce capacity, technological infrastructure, and long-term monitoring persist and must be addressed to further consolidate national ASP implementation.