Optimal implementation of Antibiotic Stewardship Programmes (ASPs) is crucial to combat antibiotic resistance in Gulf countries including the United Arab Emirates (UAE).

To evaluate ASP structure in United Arab Emirates (UAE) hospitals for seven core elements defined by Centres for Disease Control and Prevention (CDC) and World Health Organization (WHO).

A mixed-methods approach across 12 Emirates Health Services (EHS) hospitals included document reviews, surveys, and expert interviews. Document evaluation was performed on a three-point Likert scale. Online surveys distributed to a random sample of 385 employees evaluated ASP dissemination using a five-point Likert scale, analysed descriptively and through Mann–Whitney and Kruskal–Wallis tests. Interviews with programme experts were thematically analysed.

Document analysis showed six out of seven ASP core elements fully met, with accountability partially met in all hospitals. The survey (83% response rate) revealed partial ASP dissemination (median: 4; interquartile range: 2) across all elements, with significant differences between employee groups and hospitals ( P = 0.032). Interviews with 12 ASP experts identified key programme facilitators to be leadership, active interventions, pharmacist engagement, and tailored education. Barriers were inconsistent antibiotic tracking, physician resistance, lack of rapid diagnostics, competency framework, and cadre training.

EHS ASP demonstrates adequate structure but inconsistent dissemination across hospitals. This first UAE mixed-methods study benchmarks local ASP against CDC and WHO standards, aligning with high-income countries but diverging from practices in Middle East and North African countries. ASP implementation and adoption optimization needs to be explored with process and outcome indicator data focusing on prescribing, cost-effectiveness, and clinical outcomes.