Antibiotic stewardship is a genuinely well-supported practice, and a flat total does not establish that it failed. Federal officials published core elements for hospital stewardship programs in 2014, a hospital accreditation standard followed in 2017, and the Centers for Medicare and Medicaid Services adopted a rule in 2019 requiring all participating acute-care hospitals to implement such programs. Some hospital antibiotic use is necessary and appropriate, and no realistic stewardship program would drive the figure toward zero. In a hospital, antibiotics are frequently the correct treatment, and delays in appropriate therapy cause serious harm. How much did stewardship programs expand?