Beyond the ‘One-Size-Fits-All’ approach: Refining antimicrobial stewardship in Sri Lanka through stratification and triangulation

The recent launch of the national antimicrobial stewardship (AMS) programme by the Sri Lanka College of Microbiologists and the Ministry of Health marks a pivotal step in combating antimicrobial resistance. However, the current strategy, characterised largely by broad educational workshops and uniform awareness campaigns risks unintended consequences. This article critiques the ‘one-size-fits-all’ methodology, highlighting how unstratified restrictions have precipitated supply chain disruptions and antibiotic access barriers, particularly in apex tertiary care institutes. The paper argues that the prevailing "One Health" focus, while essential for public health, occasionally conflicts with patient-centric safety, specifically in the management of sepsis and provision of care to patients with sepsis and septic shock who are treated at critical care units. I propose a refined framework that moves beyond ‘low-hanging fruit’ by triangulating AMS with diagnostic stewardship and sepsis stewardship. This approach respects the heterogeneity of critical care patients and ensures that the drive to preserve antibiotics for the future does not compromise the safety of the patient today.