# Emerging Role of Emergency Physicians in Antimicrobial Stewardship

## TL;DR

Emergency physicians are becoming key leaders in managing antibiotic use to combat resistance, through improved prescribing and stewardship practices.

## Contribution

This editorial highlights the evolving role of emergency physicians in antimicrobial stewardship and outlines strategies to enhance their leadership in this area.

## Key findings

- Emergency physicians contribute to antimicrobial stewardship through guideline development and audit feedback.
- Improved prescribing practices include reduced use of broad-spectrum antibiotics and faster optimization.
- Leadership by emergency physicians is crucial for overcoming barriers like time pressure and role ambiguity.

## Abstract

The emergency department (ED) is increasingly recognized as a critical site for antimicrobial stewardship, where most initial antibiotic decisions occur, and emergency physicians (EPs), previously regarded as primarily focused on empiric treatment, are now emerging as leaders. Policy milestones, including accreditation standards and national guidelines, have catalyzed this transition, yet physician roles remain heterogeneous, and evidence on long-term outcomes is limited. Drawing on English-language literature, including intervention studies, descriptive reports, and policy documents, this editorial highlights how EPs contribute through guideline development, audit and feedback, culture follow-up, formulary oversight, rapid diagnostics, and educational initiatives. Evidence consistently shows improvements in prescribing appropriateness, reduced use of broad-spectrum agents, and faster optimization without compromising safety. However, barriers such as time pressure, professional culture, role ambiguity, and limited resources remain persistent. Importantly, the leadership of EPs has proven central in overcoming these obstacles, especially when supported by institutional commitment and integrated workflows. Their engagement is not only improving immediate prescribing practices but also represents a critical frontline defense against antimicrobial resistance and multidrug-resistant organisms. Looking forward, formalizing physician leadership, embedding stewardship in emergency medicine training, and building ED-specific data systems are essential to sustain safe and effective antibiotic use.