The stewardship balance: benefit versus harm in perioperative prophylaxis. The stewardship balance model integrates patient safety and antimicrobial stewardship into a single framework. Optimal perioperative antibiotic use occurs at equilibrium, where the benefits of infection prevention are preserved without promoting resistance or adverse drug effects. The concept translates the AWMF S3 and EAU recommendations into a visual metaphor of rational restraint. The leftward tilt corresponds to underprotection, while the rightward tilt reflects antibiotic overexposure and loss of ecological integrity.