Enhancing Antimicrobial Stewardship with the SMART-AMS Model: A Strategy for Preparing, Responding, and Protecting Public Health

Antimicrobial resistance (AMR) remains a major global health concern, intensified by the COVID-19 pandemic, which disrupted antimicrobial stewardship (AMS) practices across healthcare systems. This study aimed to develop and evaluate the SMART-AMS model, an innovative framework that integrates data-driven decision-making, real-time monitoring, and adaptive learning to improve antimicrobial prescribing, enhance patient outcomes, and reduce resistance. Guided by the UK Health Security Agency’s Start Smart, Then Focus toolkit, the study was conducted through three sequential phases and received ethical approval from the NHS and the University of Hertfordshire. It was registered under ISRCTN14825813, and public and patient involvement was incorporated through consultation with the Citizens Senate. Results identified significant disruptions to AMS during the pandemic, including fewer audits, reduced antibiotic reviews, and decreased IV-to-oral switch rates. Despite these challenges, the SMART-AMS model demonstrated potential to strengthen AMS implementation through structured interventions such as Cease, Amend, and Switch strategies. These findings highlight the model’s alignment with UKHSA objectives and its promise in supporting sustainable, equitable, and resilient AMS practices to combat AMR and protect public health. Further research is encouraged to validate its effectiveness across different healthcare settings.