For the first time in the country, Kerala has released operational guidelines for district-level AMR committees with the aim of preventing unnecessary and unscientific use of antibiotics. Additionally, operational guidelines for district AMR laboratories have been released. These laboratories will be connected through the assessment lab network, enabling us to understand the exact level of antibiotic resistance. The AMR Working Committee and District AMR Executive Committee will be constituted, with the District Medical Officer (Health) serving as chairman. The guidelines encompass the structure, functioning, monitoring, and review of these committees guidelines for primary level hospitals were released earlier.

Additionally, a new guideline has been issued to transform hospitals from taluk level to medical colleges at secondary and tertiary levels into antibiotic smart hospitals. Awareness posters regarding AMR in Malayalam should be prominently displayed in hospitals. All health workers and students must undergo training in infection control activities and AMR prevention. Prescription audits should be conducted and evaluated at least once every three months. Hospitals should establish and evaluate infection control committees and antimicrobial stewardship committees.

The implementation of WHO's surgical safety checklist in all surgical units is mandated. Initiatives to properly dispose of outdated and unused antibiotics must be undertaken, with proper monitoring conducted by hospital infection control committees. Hospitals will be declared antibiotic smart hospitals after a thorough examination and evaluation process. The state has been implementing several measures to prevent antimicrobial resistance. Kerala was the first to release state-level antibiotic guidelines, followed by district-level guidelines and the formation of AMR committees in all districts and blocks. More hospitals have been integrated into the Kerala Antimicrobial Resistance Surveillance Network (KARS-NET), further advancing efforts in combating antibiotic resistance.