Long-term care facilities (LTCFs) provide care for extended periods to older people who frequently require antimicrobials to treat and prevent infection, a leading cause of morbidity and mortality among older LTCF residents. Evidence indicates that, due to a combination of factors related to LTCF residents, prescribers and health care systems, up to 75% of antimicrobial prescriptions in LTCFs are inappropriate, in terms not only of the duration and choice of therapy, but also the need for therapy in the first place. Inappropriate use of antimicrobials is associated with the high rates of multi-drug resistant organisms that are recovered in LTCFs, and may exacerbate the threat of antimicrobial resistance (AMR), both in LTCFs and in the community. Yet, policies to tackle inappropriate antimicrobial use and AMR in LTCFs, such as antimicrobial stewardship and infection prevention and control (IPC), remain underused or suboptimal. Some countries are starting to act but they are a minority. Countries seeking to improve antimicrobial consumption, and minimise the threat of AMR, in LTCFs can: set up routine surveillance systems dedicated to collecting and reporting data on antimicrobial use and resistance in LTCFs; design, implement and enforce multifaceted antimicrobial stewardship programmes that comprehensively address multiple determinants of inappropriate antimicrobial prescribing and use; and adopt IPC programmes tailored to the specific needs and risks of LTCFs.