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Antibiotics
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Revolutionizing Infection Treatment: Cutting-Edge Approaches in Antimicrobial Stewardship
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Revolutionizing Infection Treatment: Cutting-Edge Approaches in Antimicrobial Stewardship

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: 31 May 2026 | Viewed by 12166

Special Issue Editors

Dr. Jacob Myles Keck

E-Mail Website
Guest Editor
Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
Interests: antifungal therapy; antimicrobial stewardship; HIV/AIDS; transplant ID; opportunistic infections; anti-microbial resistance
Dr. Aleksandra Barac

E-Mail Website
Guest Editor
Clinical Centre of Serbia, Belgrade, Serbia
Interests: infectious diseases; antibiotic resistance; antibacterial stewardship
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The global burden of antimicrobial resistance (AMR) is one of the most pressing public health challenges of the 21st century. To prevent further AMR, it is imperative that gaps in knowledge and clinical practice be resolved via cutting-edge clinical strategies, evidence-based tools, and multidisciplinary approaches that optimize antimicrobial therapy.

The aim of this Special Issue is to explore and promote innovative antimicrobial stewardship interventions that enhance the treatment of infections across diverse healthcare settings. This Special Issue seeks to highlight innovative strategies, technologies, and evidence-based practices that improve clinical outcomes, reduce AMR, and ensure the sustainability of effective infection management.

This Special Issue welcomes topics inlcuding innovative diagnostic tools for infection identification and treatment, strategies for personalized antimicrobial therapy, integration of technology and artificial intelligence in antimicrobial stewardship programs, clinical advancements in antimicrobial stewardship in low-resource environments, and advancements in antimicrobial stewardship in outpatient and community-based settings. Contributions are encouraged from diverse disciplines, not limited to microbiology, pharmacology, epidemiology, public health, and clinical medicine to provide a multidisciplinary perspective regarding treatment optimization. Additionally, original research articles and reviews are welcome and encouraged.

We look forward to receiving your contributions.

Dr. Jacob Myles Keck
Dr. Aleksandra Barac
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antimicrobial stewardship
  • antimicrobial resistance
  • infection treatment optimization
  • rapid diagnostics
  • technology in healthcare

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Published Papers (5 papers)

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Research

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23 pages, 3306 KB  
Article
The Impact of Antimicrobial Therapy on the Development of Microbiota in Infants
by Tatiana Priputnevich, Pavel Denisov, Ksenia Zhigalova, Vera Muravieva, Natalia Shabanova, Alexey Gordeev, Viktor Zubkov, Bayr Bembeeva, Elena Isaeva, Anastasia Nikolaeva and Gennady Sukhikh
Antibiotics 2025, 14(12), 1245; https://doi.org/10.3390/antibiotics14121245 - 9 Dec 2025
Viewed by 1178
Abstract
Background. The establishment and diversity of the gut microbiota during early childhood are fundamental for immune regulation and metabolic processes, with factors such as prematurity, delivery method, antibiotic treatment, and breastfeeding significantly impacting microbiome development and potential health outcomes. Objectives/Methods. This comparative study [...] Read more.
Background. The establishment and diversity of the gut microbiota during early childhood are fundamental for immune regulation and metabolic processes, with factors such as prematurity, delivery method, antibiotic treatment, and breastfeeding significantly impacting microbiome development and potential health outcomes. Objectives/Methods. This comparative study examined the gut microbiota composition in children aged 6–8 and 9–12 months, born via spontaneous labor at ≥38 weeks’ gestation, who either did not receive antibacterial therapy or required beta-lactam antibiotics. The composition of the colonic microbiota was analyzed in these fecal samples using a quantitative real-time PCR (qRT-PCR). Results. Significant differences in microbiota composition were observed between groups. Children treated with antibiotics exhibited a statistically significant reduction in alpha diversity indices (Shannon and Simpson), along with decreased colonization of key functionally important microorganisms, including obligate anaerobic bacteria such as Faecalibacterium prausnitzii, Clostridium leptum, Bacteroides spp., and metabolically active Bifidobacteria (B. bifidum, B. breve, B. longum). Conclusions. These microbiota alterations may adversely affect child health by diminishing microbial balance and functional potential, especially during this critical period of immune and metabolic development. The decline in anti-inflammatory, short-chain fatty acid-producing bacteria elevates the risk for allergic, atopic, dysbiotic, and metabolic conditions. Recognizing these impacts underscores the importance of strategies to supports microbiota restoration after antibiotic use, such as probiotics, prebiotics, and dietary interventions. Further research should focus on microbiota recovery dynamics to facilitate early intervention and optimize pediatric health outcomes. Overall, understanding antibiotic effects on gut microbiota can guide more judicious treatment approaches, reducing long-term health risks. Full article
(This article belongs to the Special Issue Revolutionizing Infection Treatment: Cutting-Edge Approaches in Antimicrobial Stewardship)
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16 pages, 290 KB  
Article
Antibiotic Use in Pediatrics: Perceptions and Practices of Romanian Physicians
by Alin Iuhas, Radu Galiș, Marius Rus, Codruța Diana Petcheși, Andreea Balmoș, Cristian Marinău, Larisa Niulaș, Zsolt Futaki, Dorina Matioc and Cristian Sava
Antibiotics 2025, 14(10), 976; https://doi.org/10.3390/antibiotics14100976 - 27 Sep 2025
Viewed by 985
Abstract
Background/Objectives: The global threat of antimicrobial resistance is a significant public health challenge, leading to prolonged hospitalizations, increased costs, and elevated mortality. Romania faces one of Europe’s highest burdens of antimicrobial consumption and resistance. This study aimed to investigate the factors that [...] Read more.
Background/Objectives: The global threat of antimicrobial resistance is a significant public health challenge, leading to prolonged hospitalizations, increased costs, and elevated mortality. Romania faces one of Europe’s highest burdens of antimicrobial consumption and resistance. This study aimed to investigate the factors that influence antibiotic prescribing practices among physicians in pediatric care in Romania. Method: This quantitative, cross-sectional study collected data using a self-administered, structured questionnaire from 154 healthcare professionals (family physicians, pediatricians, and other specialists) providing pediatric care in Romania. Participants were recruited via non-probability convenience sampling. The 29-question survey gathered demographic data and explored perceptions and practices regarding antibiotic therapy in children using a 5-point Likert scale. Results: The majority of participants were family physicians (64.94%) with over 15 years of experience (53.90%), primarily practicing in urban settings (61.69%). Only 21.43% had attended an antibiotic stewardship course in the last three years. Physicians generally base their prescribing on clinical symptoms. While physicians strongly agreed they follow guidelines, personal experience also held significant weight. High parental demand for antibiotics was perceived, but physicians largely denied ceding to parental tone or insistence without a medical indication. A strong consensus existed on antibiotic overuse in Romanian children, and a high interest in continuous education on rational antibiotic use was noted. Pediatricians showed significantly higher guideline adherence and diagnostic test use than family physicians. Rural physicians reported lower guideline adherence and less frequent diagnostic testing. Stewardship course participation and access to rapid diagnostic tests were associated with more evidence-based practices. Conclusions: Romanian physicians exhibit a nuanced approach to antibiotic prescribing, balancing guidelines with personal experience and facing significant perceived parental pressure. Professional profile (specialty, experience, practice environment) and access to diagnostic resources significantly influence prescribing decisions. Full article
(This article belongs to the Special Issue Revolutionizing Infection Treatment: Cutting-Edge Approaches in Antimicrobial Stewardship)
15 pages, 475 KB  
Article
Trends in ‘Watch’ and ‘Reserve’ Antibiotic Use in Primary Care in Kazakhstan: The Imperative for Enhancing Stewardship Strategies
by Kamila Akhmetova, Larissa Makalkina, Lyudmila Pivina, Lisa Lim, Nurlan Aukenov, Kuandyk Boranbayev, Rimantas Stukas, Tatiana Belikhina, Nurgul Aldiyarova, Assiya Turgambayeva and Yuliya Semenova
Antibiotics 2025, 14(10), 963; https://doi.org/10.3390/antibiotics14100963 - 25 Sep 2025
Cited by 3 | Viewed by 2133
Abstract
Background/Objectives: This study aimed to analyze the consumption of systemic antibacterials (WHO ATC J01) in primary care in Kazakhstan from 2017 to 2024 and to estimate the potential contribution of different primary care providers to the use of “Watch” and “Reserve” antibiotics. [...] Read more.
Background/Objectives: This study aimed to analyze the consumption of systemic antibacterials (WHO ATC J01) in primary care in Kazakhstan from 2017 to 2024 and to estimate the potential contribution of different primary care providers to the use of “Watch” and “Reserve” antibiotics. Methods: The Global Antimicrobial Resistance and Use Surveillance System methodology was applied to calculate defined daily doses per 1000 inhabitants per day (DID) for ATC J01 overall, as well as at ATC levels 3 and 5. Forecast modeling was performed using ARIMA (0,1,0), ARIMA (0,0,0), and Simple models to project trends through 2030. Pearson’s correlation was computed for each category of primary healthcare provider and each chemical agent belonging to the “Watch” and “Reserve” groups. Results: Antibiotic consumption increased by approximately 1.5 times in 2024 after remaining relatively stable from 2017 to 2023. The forecasts suggest that the share of “Access” group antibiotics will continue to decline, reaching 33.71% by 2030, whereas the share of “Watch” group antibiotics is expected to increase proportionally, reaching 65.73% by 2030. The per capita densities of primary care providers correlate with the consumption of certain “Watch” and “Reserve” group antibiotics. Conclusions: This study demonstrates that the primary care sector in Kazakhstan is characterized by a disproportionately high and increasing use of “Watch” antibiotics, a rising trend in “Reserve” antibiotic consumption, and a declining share of “Access” antibiotics. These findings highlight a need to prioritize stewardship interventions that target the reduction in “Watch” and “Reserve” antibiotics, while promoting the use of “Access” antibiotics. Full article
(This article belongs to the Special Issue Revolutionizing Infection Treatment: Cutting-Edge Approaches in Antimicrobial Stewardship)
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Review

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26 pages, 3527 KB  
Review
A Century of Bacteriophages: Insights, Applications, and Current Utilization
by Sadika Dkhili, Miguel Ribeiro and Karim Ben Slama
Antibiotics 2025, 14(11), 1080; https://doi.org/10.3390/antibiotics14111080 - 27 Oct 2025
Cited by 3 | Viewed by 4193
Abstract
Bacteriophages or phages are viruses that exclusively target and replicate within bacteria, acting as natural predators in the biosphere. Since their discovery over a century ago, host-specific bacteriophages have been widely advocated as a cost-effective and adaptable approach to controlling and combating bacterial [...] Read more.
Bacteriophages or phages are viruses that exclusively target and replicate within bacteria, acting as natural predators in the biosphere. Since their discovery over a century ago, host-specific bacteriophages have been widely advocated as a cost-effective and adaptable approach to controlling and combating bacterial infections. Antibiotic resistance, a growing concern and a significant global public health problem, has further underscored the importance of bacteriophages. Nevertheless, their potential applications span diverse fields, including molecular biology, phage therapy, bacterial detection, food safety, and wastewater decontamination. Furthermore, bacteriophages represent a diverse group of viruses that are relatively easy to handle, making them suitable for use in both treatments and biotechnology research. In this review, we aim to provide a comprehensive overview of bacteriophage history, characteristics, and applications that have been employed to address human challenges, ranging from healthcare to environmental remediation. We will highlight key findings and outcomes, shedding light on ongoing research that will shape the future of bacteriophage applications. Full article
(This article belongs to the Special Issue Revolutionizing Infection Treatment: Cutting-Edge Approaches in Antimicrobial Stewardship)
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25 pages, 473 KB  
Review
“Dusting Off the Cobwebs”: Rethinking How We Use New Antibiotics
by Jacob Myles Keck, Jacob Schultz and Alina Viteri
Antibiotics 2025, 14(9), 862; https://doi.org/10.3390/antibiotics14090862 - 27 Aug 2025
Cited by 2 | Viewed by 2892
Abstract
Antimicrobial resistance continues to escalate worldwide, threatening effective medical care, patient safety, and global health security. Traditional antibiotics are increasingly unreliable against multidrug-resistant pathogens, resulting in delayed appropriate therapy, prolonged illness, higher healthcare costs, and increased mortality. In this context, antimicrobial stewardship must [...] Read more.
Antimicrobial resistance continues to escalate worldwide, threatening effective medical care, patient safety, and global health security. Traditional antibiotics are increasingly unreliable against multidrug-resistant pathogens, resulting in delayed appropriate therapy, prolonged illness, higher healthcare costs, and increased mortality. In this context, antimicrobial stewardship must evolve beyond the preservation of older drugs to include the judicious, evidence-based use of newer antibiotics. When used empirically in high-risk scenarios, novel agents can improve clinical outcomes by ensuring timely, effective coverage against MDR organisms while reducing the need for broad-spectrum combinations that drive collateral resistance and adverse effects. A major challenge, however, is the underutilization of these agents, which not only limits patient benefit but also undermines incentives for continued pharmaceutical innovation. To address this gap, stewardship programs must incorporate strategies for appropriate empiric deployment of new antibiotics, guided by local epidemiology, risk stratification, rapid diagnostics, and multidisciplinary decision-making. A coordinated global effort, linking stewardship, innovation, and policy reform, will be critical to optimize the role of novel antimicrobials in clinical practice moving forward. Full article
(This article belongs to the Special Issue Revolutionizing Infection Treatment: Cutting-Edge Approaches in Antimicrobial Stewardship)
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