The irrational use of antimicrobial agents will exacerbate the crisis of antimicrobial resistance. In recent years, China has attached great importance to the management of antimicrobial agents, actively promoting the implementation of antimicrobial stewardship (AMS). Although the antimicrobial use density (AUD) has decreased significantly, numerous challenges still persist in the antimicrobial management practices within medical institutions. This paper systematically reviews the persistent issues related to antimicrobial use and management within medical institutions, summarizes the efficacy and practical outcomes of key intervention strategies. These strategies involve multidisciplinary collaboration, enhancement of infection management professional skills, data-driven management, building of informatization systems, and the application of the Plan-Do-Check-Act (PDCA) cycle. Evidence confirms that robust administrative support, high-level professional expertise in infection diagnosis and treatment, and reliable execution capacity together serve as the core pathway towards rational antimicrobial use. This review aims to provide a replicable scientific framework and practical reference for medical institutions at all levels to optimize their antimicrobial management protocols.