This article summarizes selected points from the presentation given at the First Antibiotic Stewardship Program in September 1997 at Niagara-on-the-Lake. The author’s opinions regarding a novel system of antibiotic monitoring called pharmLINK, as used in North York General Hospital (NYGH), are represented. NYGH is a mid-sized, regional referral hospital in Toronto, Ontario with approximately 450 beds (varying up to a capacity of 650 beds) involved largely in the secondary-level care of patients with a few select tertiary care level units. General medical, surgical, obstetrical/gynecological and paediatric services are provided at the hospital. While physician autonomy in the prescribing of medications was the norm in the early 1980s, the increasing number of available antibiotics and acknowledgement that both cost effectiveness and rising bacterial resistance were clinically relevant problems spurred the establishment of a Subcommittee on Antibiotic Usage in October, 1987. The committee was established to monitor and control antibiotic use through direct intervention and information bulletins, and by developing policies pertaining to the promotion of appropriate use. A number of mechanisms of intervention described in the literature have been tried with varying success. Some practitioners viewed direct restrictions or mandatory automatic substitution policies as a threat to the integrity of their practices. The fear of litigation if a ‘less broad-spectrum’ (implied to be less effective) antibiotic were prescribed was often cited as the reason to prescribe more costly medications. Reluctance to complete paperwork to justify the use of a particular agent and overall unwillingness to accept therapeutic suggestions from other health care professionals were other reasons for incomplete success in employing these interventions. Unlike in most institutions, prescribing of certain antibiotics has never required consultation or review by the Infectious Diseases (ID) specialist thus leading in certain cases to clinically less optimal or more costly outcomes. Staff education by means of ‘in-services’, grand rounds or seminars, while effective for brief periods of time, required repetition and commitment to maintain an adequate level of awareness. As the 1990s brought the issues of cost containment and responsible prescribing more urgently to the forefront in Canadian hospitals, alternative mechanisms of antibiotic stewardship were attempted. Joint efforts among the microbiology laboratory, the infection control practitioner, the (ID) specialist and the pharmacy resulted in the publication of a free handbook for staff that provided guidelines for antimicrobial use. Similar to handbooks available in other institutions, this publication was customized to the environment of the NYGH by using abbreviated information found in known published manuals. Through tables identifying types, frequencies and susceptibility patterns of the most common bacteria isolated at NYGH, as well as the best antimicrobial choices according to common diagnoses, physicians were provided with options and direction rather than inflexible rules. This handbook is periodically updated to reflect changes in bacterial susceptibility trends and as new agents are introduced to the formulary. To facilitate better prescribing practices and monitor antibiotic use more efficiently a new computer system and software were acquired, linking the microbiology and pharmacy department databases and allowing timely intervention in drug use. The purchase of pharmLINK (Dade MicroScan, West Sacramento) enabled improved antibiotic prescribing and, ultimately, better patient care. Cost savings were realized, and overall satisfaction with this system has been high. A specially trained drug utilization (DU) pharmacist was assigned the task of implementing the system.