Antimicrobial Resistance: a One Health Perspective.

Approaching any issue from a One Health perspective necessitates looking at the interactions of people, domestic animals, wildlife, plants, and our environment. For antimicrobial resistance this includes antimicrobial use (and abuse) in the human, animal and environmental sectors. More importantly, the spread of resistant bacteria and resistance determinants within and between these sectors and globally must be addressed. Better managing this problem includes taking steps to preserve the continued effectiveness of existing antimicrobials such as trying to eliminate their inappropriate use, particularly where they are used in high volumes. Examples are the mass medication of animals with critically important antimicrobials for humans, such as third generation cephalosporins and fluoroquinolones, and the long term, in-feed use of antimicrobials, such colistin, tetracyclines and macrolides, for growth promotion. In people it is essential to better prevent infections, reduce over-prescribing and over-use of antimicrobials and stop resistant bacteria from spreading by improving hygiene and infection control, drinking water and sanitation. Pollution from inadequate treatment of industrial, residential and farm waste is expanding the resistome in the environment. Numerous countries and several international agencies have now included a One Health Approach within their action plans to address antimicrobial resistance. Necessary actions include improvements in antimicrobial use, better regulation and policy, as well as improved surveillance, stewardship, infection control, sanitation, animal husbandry, and finding alternatives to antimicrobials.

Background: Antimicrobial resistance (AMR) is a global health challenge that has escalated due to the inappropriate use of antimicrobials in humans, animals, and the environment. Developing and implementing strategies to reduce and combat AMR is critical. Purpose: This study aimed to highlight some global strategies that can be implemented to address AMR using a One Health approach. Methods: This study employed a narrative review design that included studies published from January 2002 to July 2023. The study searched for literature on AMR and antimicrobial stewardship (AMS) in PubMed and Google Scholar using the 2020 PRISMA guidelines. Results: This study reveals that AMR remains a significant global public health problem. Its severity has been markedly exacerbated by inappropriate use of antimicrobials in humans, animals, and the broader ecological environment. Several strategies have been developed to address AMR, including the Global Action Plan (GAP), National Action Plans (NAPs), AMS programs, and implementation of the AWaRe classification of antimicrobials. These strategies also involve strengthening surveillance of antimicrobial consumption and resistance, encouraging the development of new antimicrobials, and enhancing regulations around antimicrobial prescribing, dispensing, and usage. Additional measures include promoting global partnerships, combating substandard and falsified antimicrobials, advocating for vaccinations, sanitation, hygiene and biosecurity, as well as exploring alternatives to antimicrobials. However, the implementation of these strategies faces various challenges. These challenges include low awareness and knowledge of AMR, a shortage of human resources and capacity building for AMR and AMS, in adequate funding for AMR and AMS initiatives, limited laboratory capacities for surveillance, behavioural change issues, and ineffective leadership and multidisciplinary teams. Conclusion: In conclusion, this study established that AMR is prevalent among humans, animals, and the environment. Successfully addressing AMR calls for a collaborative, multifaceted One Health approach. Despite this, some gaps remain effectively implementing strategies currently recommended to combat AMR. As a result, it is essential to reinforce the strategies that are deployed to counter AMR across the human, animal, and environmental sectors.

BackgroundDevelopment of antimicrobial resistance poses a major threat to human and animal health worldwide. Antimicrobials are frequently used in animal husbandry, making food-producing animals a widespread and important source of antimicrobial resistance. Indeed, recent evidence demonstrates that antimicrobial resistance in food-producing animals poses a threat to the health of humans, animals and the environment. To address this threat, national action plans have been implemented based on a ‘One Health’ approach, which integrates actions across human and animal health sectors to combat antimicrobial resistance. Although under development, Israel has yet to publish a national action plan against antimicrobial resistance, despite alarming findings of resistant bacteria in food-producing animals in the country. Here we review several national action plans against antimicrobial resistance around the world in order to suggest approaches to develop a national action plan in Israel.Main bodyWe investigated worldwide national action plans against antimicrobial resistance based on a ‘One Health’ approach. We also conducted interviews with representatives of relevant Israeli ministries to understand antimicrobial resistance policy and regulatory frameworks in Israel. Finally, we present recommendations for Israel towards implementing a ‘One Health’ national action plan against antimicrobial resistance. Many countries have developed such plans, however, only a few are currently funded. Furthermore, many countries, especially in Europe, have taken action to reduce the use of antimicrobials and the spread of antimicrobial resistance in food-producing animals by banning the use of antimicrobials to promote growth, reporting data on the use and sales of antimicrobials in food-producing animals, operating centralized antimicrobial resistance surveillance systems and preventing the use of antimicrobials important to human medicine to treat food-producing animals.ConclusionsWithout a comprehensive and funded national action plan, the risks of antimicrobial resistance to the public health in Israel will escalate. Thus, several actions should be considered: (1) Reporting data on the use of antimicrobials in humans and animals. (2) Operating a centralized surveillance system for antimicrobial resistance in humans, animals and the environment. (3) Improving awareness regarding antimicrobial resistance in the general public and in health practitioners from both human and animal sectors. (4) Composing a list of critically important antimicrobials to human medicine that’s use should be avoided in food-producing animals. (5) Enforcing best practices of antimicrobial use at the farm-level. (6) Reducing incidence of infection through farm biosecurity. (7) Supporting research and development of new antimicrobial treatments, vaccines and diagnostic tools.

Singapore’s Antimicrobial Resistance (AMR) national strategic action plan includes inappropriate use of antimicrobials in food-producing animals as a specific priority. Although the use of antibiotics and other drugs are monitored by regulatory bodies, food fish farmers are allowed to buy and administer antimicrobials without a veterinary prescription. We conducted a qualitative study of Singaporean food fish farmers to understand patterns and determinants of antibiotic use, their knowledge of antibiotic resistance, as well as perceptions of on-farm infection prevention and control measures. During the interview, participants were asked about their farming processes, farm infrastructure, antibiotic use and any disease prevention measures. Thematic analysis of participants’ interviews showed that antibiotic for growth promotion and infection prevention was uncommon among local food fish farmers. The following three main themes influenced participants’ decisions to use antibiotics in their practice: 1) individual factors, 2) local regulatory factors as well as 3) market-related factors. Individual factors included their personal experience and knowledge both with antibiotics as well as with alternate options. In terms of local regulatory factors, we found that regular oversight was a strong deterrent in antibiotic use. Last, at the market level, the relatively high price of antibiotics in Singapore coupled with stiff competition was a strong disincentive for participants to use antibiotics in their farming practice. These factors were also influential in their relationships with local regulatory bodies as well as their counterparts. Although industries differ significantly across countries, lessons learnt from Singapore’s food fish farming demonstrate the importance of an environment where multi-dimensional factors come together to discourage the irrational use of antibiotics in food animal production. In addition, our results allow greater insight into food fish farmers’ perspectives on infection control and form a basis from which further research work can be undertaken.

One Health: a call for ecological equity

Antibiotics have saved millions of human lives, and their use has contributed significantly to improving human and animal health and well-being. Use of antibiotics in food-producing animals has resulted in healthier, more productive animals; lower disease incidence and reduced morbidity and mortality in humans and animals; and production of abundant quantities of nutritious, high-quality, and low-cost food for human consumption. In spite of these benefits, there is considerable concern from public health, food safety, and regulatory perspectives about the use of antimicrobials in food-producing animals. Over the last two decades, development of antimicrobial resistance resulting from agricultural use of antibiotics that could impact treatment of diseases affecting the human population that require antibiotic intervention has become a significant global public health concern. In the present review, we focus on antibiotic use in lactating and nonlactating cows in U.S. dairy herds, and address four key questions: (1) Are science-based data available to demonstrate antimicrobial resistance in veterinary pathogens that cause disease in dairy cows associated with use of antibiotics in adult dairy cows? (2) Are science-based data available to demonstrate that antimicrobial resistance in veterinary pathogens that cause disease in adult dairy cows impacts pathogens that cause disease in humans? (3) Does antimicrobial resistance impact the outcome of therapy? (4) Are antibiotics used prudently in the dairy industry? On the basis of this review, we conclude that scientific evidence does not support widespread, emerging resistance among pathogens isolated from dairy cows to antibacterial drugs even though many of these antibiotics have been used in the dairy industry for treatment and prevention of disease for several decades. However, it is clear that use of antibiotics in adult dairy cows and other food-producing animals does contribute to increased antimicrobial resistance. Although antimicrobial resistance does occur, we are of the opinion that the advantages of using antibiotics in adult dairy cows far outweigh the disadvantages. Last, as this debate continues, we need to consider the consequences of "what would happen if antibiotics are banned for use in the dairy industry and in other food-producing animals?" The implications of this question are far reaching and include such aspects as animal welfare, health, and well-being, and impacts on food quantity, quality, and food costs, among others. This question should be an important aspect in this ongoing and controversial debate.

Introduction: Antimicrobial resistance (AMR) remains a critical global health issue contributing to increased morbidity and mortality. Antimicrobial stewardship (AMS), surveillance, and infection prevention and control (IPC) programs have been established and implemented to mitigate this crisis. Alongside this, advancements in nanotechnology and artificial intelligence (AI) or machine learning have enhanced academic tone and readability in combating AMR. This study employed a comprehensive narrative review approach to provide detailed evidence of AMS programs initiated to address AMR across One-Health sectors (human, animal, plant, and environmental health). Methods: A comprehensive narrative review was conducted to assess the global implementation of AMS, surveillance, and IPC programs, nanotechnology, and AI aimed at curtailing the rising prevalence of AMR. We also focused on the impacts of these AMS programs across diverse populations and settings. Relevant literature published between January 1995 and June 2025 was extracted from PubMed, Google Scholar, and Scopus databases. Results: The findings of this review demonstrate that AMS, surveillance, and IPC programs have been successfully established and implemented in some hospitals, community pharmacies, academic institutions, communities, and animal health. These programs have significantly promoted the rational use of antimicrobials in the One Health sector, prevented infections, reduced the emergence of antibiotic-resistant bacteria, improved adherence to treatment guidelines, awareness and knowledge of AMR, and patient outcomes. Advancements in technology, including nanotechnology and AI/machine learning, have shown promise in enhancing AMS and surveillance programs aimed at combating AMR. However, there is a dearth of empirical data on AMS activities within the environmental and animal health sectors, pointing out a critical gap in the One Health approach to AMR mitigation. Conclusions: This review underscores the importance of developing and implementing AMS, surveillance, and IPC programs as effective strategies to combat AMR using a One Health approach. Consequently, the study found very little information regarding AMS activities in the animal and environmental health sectors despite global problems as climate change. Notably, this study emphasizes the importance of embracing nanotechnology and AI within the healthcare system as innovative tools to combat AMR. It further highlights the need to promote integrated AMS, IPC, and surveillance programs across the One Health continuum, leveraging all available strategies to effectively combat AMR.

A major driver of antimicrobial resistance (AMR) is the inappropriate use of antimicrobials. At the community level, people are often engaged in behaviors that drive AMR within human, animal, and environmental (One Health) impacts. This scoping review consolidates research to determine (a) the community's knowledge, attitudes, and practices around AMR; (b) existing community-based interventions; and (c) barriers and enablers to addressing AMR in Nepal. This scoping review follows the Joanna Briggs Institute scoping review methodology. Literature indexed in PubMed, Scopus, CINAHL, Global Index Medicus, HINARI-SUMMON, Embase (Ovid), Global Health (Ovid), CAB Abstracts (Ovid), Web of Science, and Google Scholar between January 2000 and January 2023 were reviewed for inclusion. Articles were included in the review if they considered the issues of AMR at the community level in Nepal; this excluded clinical and laboratory-based studies. A total of 47 studies met these criteria, were extracted, and analyzed to consolidate the key themes. A total of 31 (66%) articles exclusively included human health; five (11%) concentrated only on animal health; no studies solely focused on environmental aspects of AMR; and the remaining studies jointly presented human, animal, and environmental aspects. Findings revealed inadequate knowledge accompanied by inappropriate practice in both the human and animal health sectors. Four community interventions improved knowledge and practices on the appropriate use of antimicrobials among community people. However, various social and economic factors were found as barriers to the appropriate use of antimicrobials in the community. Community engagement and One Health approaches could be key tools to improve awareness of AMR and promote behavioral change related to AM use in communities, as current studies have revealed inadequate knowledge alongside inappropriate practices shared in both human and animal health sectors. DOI: 10.17605/OSF.IO/FV326.

Background Antimicrobial resistance (AMR) is a pressing global public health challenge that requires coordinated multisectoral responses. In line with the Global Action Plan (GAP) on AMR, Jordan developed its first National Action Plan (NAP) for 2018–2022 to guide multisectoral efforts. This study aimed to evaluate the implementation of Jordan's AMR NAP, identify progress and challenges across its five strategic objectives, and suggest actionable recommendations for strengthening future AMR responses. Methods The Jordan Center for Disease Control (Jordan CDC) conducted a comprehensive 'end-term evaluation' for the NAP 2018–2022. Data were collected from approximately seventy national stakeholders through a national workshop and follow-up electronic communications. The evaluation tool included sector-specific and multisectoral indicators aligned with the NAP's five objectives. Descriptive statistical analysis was performed using SPSS to determine implementation rates across human, animal, and environmental health sectors, applying the One Health approach. Results The evaluation revealed uneven implementation across NAP objectives, with notable achievements in the rational use of antimicrobials (69%) completion, mainly in the human health sector. Infection prevention and control (IPC) efforts reached (63%), while surveillance-related activities achieved (56%). Awareness-related activities reported limited progress (47%), and no activities were implemented under the research and innovation objective. Multisectoral collaboration was limited, particularly in the animal and environmental sectors. Significant barriers included the absence of a unified communication strategy, lack of dedicated funding, insufficient investment in human resources and laboratories, and disruptions caused by the Coronavirus Disease 2019 (COVID-19) pandemic. Conclusions Despite progress in different areas, the overall implementation revealed significant challenges, particularly in research, multisectoral collaboration, and One Health integration. Future action should prioritize a unified national AMR policy framework for strategic planning, emphasizing resource distribution, active participation of all relevant sectors, and systematic monitoring and evaluation to inform policymaking. Strengthening coordination between human, animal, and environmental sectors is essential to achieving a robust, One Health-aligned AMR response in Jordan.

BackgroundAntimicrobial use in food-producing animals selects for antimicrobial resistance that can be transmitted to humans via food or other transmission routes. The World Health Organization (WHO) in 2005 ranked the medical importance of antimicrobials used in humans. In late 2017, to preserve the effectiveness of medically important antimicrobials for humans, WHO released guidelines on use of antimicrobials in food-producing animals that incorporated the latest WHO rankings.MethodsWHO commissioned systematic reviews and literature reviews, and convened a Guideline Development Group (GDG) of external experts free of unacceptable conflicts-of-interest. The GDG assessed the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, and formulated recommendations using a structured evidence-to-decision approach that considered the balance of benefits and harms, feasibility, resource implications, and impact on equity. The resulting guidelines were peer-reviewed by an independent External Review Group and approved by the WHO Guidelines Review Committee.ResultsThese guidelines recommend reductions in the overall use of medically important antimicrobials in food-producing animals, including complete restriction of use of antimicrobials for growth promotion and for disease prevention (i.e., in healthy animals considered at risk of infection). These guidelines also recommend that antimicrobials identified as critically important for humans not be used in food-producing animals for treatment or disease control unless susceptibility testing demonstrates the drug to be the only treatment option.ConclusionsTo preserve the effectiveness of medically important antimicrobials, veterinarians, farmers, regulatory agencies, and all other stakeholders are urged to adopt these recommendations and work towards implementation of these guidelines.

Tackling antimicrobial resistance in food-producing animals

Veterinarians approach towards antimicrobial stewardship and one health: A survey study.

A rational response by WHO to the crisis in antimicrobial resistance Tackling antimicrobial resistance (AMR) is a priority of the World Health Organization’s public health agenda, and in November 2017...

Resistance to antimicrobials is a growing global concern for public and animal health. There is increasing pressure aimed at reducing the use of antimicrobials in food-producing animals in the European Union (EU) and elsewhere through implementation measures and incentives, with the objective to reduce the occurrence of antimicrobial resistance (AMR) in bacteria from food-producing animals and food. Accordingly, the use of antimicrobials in food-producing animals has significantly decreased in the EU and there have been considerable efforts in the identification and development of possible alternatives to antimicrobials, such as vaccines. It is now widely recognized and reported that vaccination may contribute to reducing antimicrobial use in food-producing animals and may indirectly reduce the risk of antimicrobial selection and/or development of AMR. Vaccines against bacterial infections and immunosuppressive viruses are especially relevant in this regard. The article briefly reviews the current status and trends relating to the development and availability of vaccines that may be of interest in reducing the use of antimicrobials. Possible opportunities are discussed, with a specific focus on regulatory requirements. Clearly, veterinary vaccines have a part to play and support for innovation in the area remains critically important. This article is part of the Royal Society Science+ meeting issue 'Vaccines and antimicrobial resistance: from science to policy'.

Dominique L. Monnet, Lennox K. Archibald, Lisa Phillips, Fred C. Tenover, John E. McGowan Jr., Robert P. Gaynes, Intensive Care Antimicrobial Resistance Epidemiology Project, National Nosocomial Infections Surveillance System Hospitals, Antimicrobial Use and Resistance in Eight US Hospitals: Complexities of Analysis and Modeling, Infection Control and Hospital Epidemiology, Vol. 19, No. 6 (Jun., 1998), pp. 388-394