Antimicrobial Stewardship Program

In 2008, Markham Stouffville Hospital took a proactive approach to managing antimicrobial use by launching its Antimicrobial Stewardship Program (ASP).  Director of Pharmacy, Shellyna Moledina, noticed successful programs in the United States and other hospitals in Ontario and approached senior management to implement the program.

Dr. Jeya Nadarajah, ASP Lead; ASP Pharmacists Sabrina Chan, Linda Guo and Christine Howe

The therapy of patients throughout the hospital is now assessed by the ASP on a daily basis. The ASP team is spearheaded by Infectious Diseases specialist Dr Jeya Nadarajah and several pharmacists with additional training in antimicrobial use. Their  recommendations may include altering the route of administration, antimicrobial spectrum of activity, duration of therapy, or discontinuing therapy. They have also implemented a number of guidelines and policies to promote rational use of antimicrobials. These include a pharmacist-lead intravenous to oral conversion strategy and the creation of surgical prophylaxis and urinary tract infection treatment guidelines to name a few.

The team’s ultimate goal is to prevent antimicrobial-related complications, such as the emergence of antibiotic-resistant bacteria and Clostridium difficile infection,  and to reduce hospital costs. The team has developed a ‘culture of respect and trust’ within Markham Stouffville Hospital. By routinely meeting with medical staff to discuss and evaluate the program, they promote the importance of stewardship and open communication. Staff address challenges and formulate solutions together to strengthen the ASP. For more information, see our Antimicrobial Stewardship Profile on the Ontario Public Health website.

In 2018,  the MSH ASP launched the Spectrum app for desktop and mobile devices featuring MSH-specific treatment guidelines for infections, local antibiograms, antimicrobial dosing, beta-lactam allergy assessment and much more!  The content was developed by the MSH ASP team and the app is free to download, visit