Community-acquired infections and stewardship practices — A Call to Action for a community physician (COMMUNITY Steward model)

Abstract

Community-acquired infections (CAIs) account for the bulk of antimicrobial prescriptions in outpatient and primary-care settings. In India, syndromes such as community-acquired pneumonia, acute diarrhoeal disease, urinary tract infections, skin and soft-tissue infections, enteric fever, and seasonal vector-borne infections (dengue, scrub typhus, leptospirosis) drive antimicrobial demand and — when managed inappropriately — accelerate antimicrobial resistance (AMR). Community physicians occupy the gatekeeper role: their diagnostic choices, prescribing thresholds, advice on vaccination and prevention, and engagement with pharmacists and public-health systems determine how antibiotics are used at population scale. This editorial orders common CAIs by typical prevalence in community practice, outlines stewardship priorities for each, and adapts the Society of Antimicrobial Stewardship PractIces (SASPI) in India’s integrated stewardship framework for community settings. Practical actions (COMMUNITY Steward model) include syndromic triage supported by point-of-care tests, narrow-spectrum empiric choices with rapid review, limiting durations, vaccination advocacy, and community surveillance. Strengthening these measures at the primary-care level is essential to slow AMR while maintaining good patient care.