Objective To explore the application efficacy of refined management on antimicrobial agents in a chest specialty hospital. Methods Multiple measures were implemented through perfecting management systems and processes, as well as conducting knowledge training, such as multi-dimensional specialized prescription reviewing, optimizing information systems, and implementing grid-based management of clinical pharmacist. A refined management mode for antimicrobial agents in a chest specialty hospital has been established. Antimicrobial management indicators for the whole hospital and each clinical specialty in 2023 (before management) and 2024 (after management) were analyzed. Results Compared with 2023, antimicrobial use rate among hospitalized patients in 2024 decreased from 47.48% to 45.92%, and antimicrobial use density (AUD) decreased from 46.28 defined daily doses (DDDs)/(100 person · day) to 39.73 DDDs/(100 person · day). The ratio of antimicrobial cost to total drug cost decreased from 12.71% to 9.51%, and the per capita cost of antimicrobial use decreased from 1 344.18 Yuan to 975.52 Yuan. The use rate of prophylactic antimicrobial agents for class Ⅰ incision surgery increased from 84.48% to 89.52%, and the rationality rate increased from 69.25% to 94.53%. The management indicators of each clinical specialty improved significantly. Conclusion Through adopting a series of refined management measures, antimicrobial management modes that are suitable for the actual situation of the hospital has been constructed, and obvious efficacy was achieved. Clinical application of antimicrobial agents is more standardized and rational.