Background: Respiratory tract infections are among the most frequent reasons for prescription of antibiotics. Antimicrobial stewardship (AMS) can promote the rational use of antibiotics and prevent the development of resistance through targeted interventions such as treatment recommendations, ward rounds and training. 

Objective (research question): The review article presents the impact and limitations of AMS programs in respiratory tract infections, especially community-acquired pneumonia (CAP) and hospital-acquired (nosocomial) pneumonia (HAP).

Material and methods: An analysis and discussion of current guidelines, studies and meta-analyses on AMS interventions in pneumological infections are presented. 

Results: The treatment of CAP shows discrepancies between guideline recommendations and clinical practice, particularly regarding treatment duration and sequential oral treatment. The use of AMS interventions is effective in optimizing these aspects. The HAP poses a challenge in establishing the diagnosis and assessing the risk of multidrug-resistant organisms (MDRO), which likely lead to overtreatment. The use of AMS measures, such as re-evaluation of diagnosis and treatment within 48–72 h are decisive instruments for de-escalating and focusing treatment. In complex cases and unfavorable courses of disease, more a comprehensive assessment through infectious disease consultations can be beneficial. 

Discussion: The use of AMS can improve the quality of treatment for pulmonary infections and reduce overtreatment. Limitations include complex disease courses, challenging diagnostics and individual patient factors, which often require the expertise of infectious diseases specialists. The AMS as a systematic approach and co-management by infectious diseases specialists complement each other in optimizing the management of lung infections.