Standard Treatment Workflows: scaling system-compatible approaches to rational antibiotic use.

Antimicrobial resistance (AMR) threatens the effectiveness of essential medicines, particularly in resource-constrained health systems where high patient volumes, limited diagnostic capacity and inconsistent guideline adherence influence antibiotic prescribing. India faces a substantial AMR burden, with national surveillance reporting carbapenem resistance exceeding 80% in Klebsiella pneumoniae and over 90% in Acinetobacter baumannii bloodstream isolates. In response, the Indian Council of Medical Research (ICMR) has developed Standard Treatment Workflows (STWs) concise, evidence-based, point-of-care clinical guidance intended to support rational antibiotic use across levels of care. This Practise paper examines the stewardship orientation, system compatibility and readiness for scale-up of STWs to inform their wider adoption. We reviewed 157 STWs addressing conditions requiring antibiotic therapy and mapped recommended agents against the WHO Access-Watch-Reserve (AWaRe) classification, the National List of Essential Medicines (NLEM) and Indian Public Health Standards (IPHS). The recommended antibiotics predominantly fall within the WHO Access category and are largely drawn from medicines listed in India's NLEM. These features indicate strong alignment of STWs with antimicrobial stewardship principles and existing health system capacities. ICMR Standard Treatment Workflows are a stewardship-aligned, system-compatible clinical guidance tool with strong readiness for scale-up; this paper argues for their adoption in India and their relevance for other high-burden health systems.