Antimicrobial Use and Resistance in Pigs and Chickens: A Review of the Science, Policy and Control Practices from Farm to Slaughter – Executive Summary

BackgroundInappropriate use of antimicrobials in both humans and animals is a key driver of antimicrobial resistance (AMR). In addition, human behaviours such as poor disposal of antimicrobials in the environment can increase their exposure to microbes which can impact on humans and animals. However, evidence on access, use and disposal of antimicrobials for humans and animals at community level in Uganda is limited. This study therefore explored access, use and disposal of antimicrobials among humans and animals in Wakiso district, Uganda.MethodsA qualitative study was conducted that involved focus group discussions (FGDs) and key informant interviews (KIIs). Participants of the FGDs were community health workers (CHWs) and farmers involved in animal husbandry, while key informants included: officials from the Ministry of Health; Ministry of Agriculture, Animal Industry and Fisheries; human and animal health professionals; district health officials; and members of the national AMR surveillance committee. Twelve FGDs were held (8 for CHWs and 4 for farmers) while 15 KIIs were conducted. Thematic analysis in NVivo (version 12) was performed.ResultsFive main themes emerged from the study: access to antimicrobials in humans; access to antimicrobials in animals; use of antimicrobials in humans; use of antimicrobials in animals; and disposal of antimicrobials. Community members mainly accessed antimicrobials for humans from public health facilities such as government health centres, as well as private facilities, including drug shops and clinics. Antimicrobials for animals were obtained from veterinary practitioners and drug shops (both for humans and veterinary). Examples of inappropriate use of antimicrobials in both humans and animals was evident, such as sharing antibiotics among household members, and giving human-prescribed antimicrobials to food-producing animals as growth promoters. While some CHWs returned unused antimicrobials to public health facilities for proper disposal, community members mainly disposed of antimicrobials with general household waste including dumping in rubbish pits.ConclusionsThere is a need to increase awareness among the population on proper access, use and disposal of antimicrobials for both humans and animals. Development of a drug disposal system at community level would facilitate improved waste management of antimicrobials. Together, these measures would help prevent the rate of progression of AMR in communities.

Political attention to antimicrobial resistance (AMR) has never been greater. Governments worldwide are concerned that AMR threatens to undo modern medical achievements with the spectre of a post antibiotic era in which commonplace infections, once eminently treatable, become nontreatable causes of serious morbidity and mortality 1. With suggestions that AMR and multi-drug resistant organisms are as important as climate change and could cast the world back into the dark ages of medicine, ranking alongside terrorism as matters of national risk 2, 3, the political landscape on this subject has been clearly set. Concerns about AMR and its health impact are, of course, not new and began at almost the same time as the introduction of antimicrobials. In 1945, just after the introduction of penicillin as a therapeutic agent in humans and animals, Fleming warned in his Nobel Prize acceptance speech that misuse of antimicrobials could result in bacterial resistance. This prediction rapidly became true with the discovery of each new class of antimicrobial quickly followed by the appearance of resistance to it. By the 1960s there was widespread realisation, and acceptance in the scientific community and lay press, that antimicrobial use (and misuse) resulted in rapid selection for resistance against all classes of antimicrobials. What is new, and has changed the political and regulatory landscape for AMR completely, is the realisation that science is not able to out-pace the microbes. There have been no completely new classes of antimicrobials discovered and brought to market since the 1980s, perhaps not surprising given the relatively small range of bacterial targets and the rapid rate of antimicrobial discovery during the ‘golden age’ from the mid 1940s onwards 4. Although there are some rays of hope, for example the recently reported new compound ‘teixobactin’ 5, the pipeline for new antimicrobials is practically dry. In other words, the solutions to AMR must come from within the medical, veterinary and animal industry sectors by addressing the underlying causes of, and changing the therapeutic approaches to, infectious disease. The political and scientific view that antimicrobials can no longer be regarded as the panacea or ‘magic bullet’ capable of eradicating infectious disease is widely accepted, and it is now clear that the human and animal health care sectors need to respond accordingly. A major challenge for the politicians is that there are still significant gaps in the surveillance data required to fully understand the drivers of AMR in both humans and animals 6, 7 and, critically, to measure the effects of interventional measures to reduce AMR. It is therefore not surprising that scientific opinion continues to be divided on practically every key question about AMR except that it is now a serious global problem causing significant economic loss with welfare, morbidity and mortality impacts in humans and animals. Antimicrobial resistance is a natural phenomenon: bacteria produce antimicrobial substances as part of their repertoire to compete in the struggle for colonisation, space and nutrients. Resistance therefore existed long before the introduction of antimicrobial drugs: the effect of using antimicrobials has been to accelerate AMR through classical selective pressure. That this has happened in both veterinary and human populations of bacteria is not disputed; the evidence for interconnection of AMR in these two populations is, however, inconclusive and is the subject of continuing political and scientific debate with contradictory evidence produced by both sides 8-10. It does appear that antimicrobial use in animals increases AMR in animal bacteria and that treating people with antimicrobials increases AMR in human bacteria. However, current scientific evidence does not allow definitive assessment of whether reducing antimicrobial use in animals has reduced AMR in medical pathogens. The extent to which AMR in populations of animal bacteria threatens public health therefore remains uncertain. The evidence for resistance in animal bacteria acting as genetic reservoirs of resistance for transfer to bacteria of public health importance is also inconclusive. Even for zoonotic bacteria such as Salmonella typhimurium DT104, the links between animal and human bacterial populations have become less clear with the application of sophisticated molecular typing bacterial methods and population genetics adding new complexity to the AMR debate 11. However, the lack of conclusive evidence notwithstanding, the prevailing political and regulatory opinion continues to be that antimicrobial use, and associated AMR, in animals is a driver of AMR in medical pathogens and that controlling veterinary prescription of antimicrobials will help safeguard public health. The ongoing political and public health scrutiny of veterinary use of antimicrobials is not surprising and the assumption that veterinary antimicrobial use contributes to, or is perhaps even directly the cause of, AMR in human medicine is understandable. The fact that the classes of antimicrobials used in veterinary and human medicine are the same 12; that food-borne and other zoonotic infections provide an opportunity for transfer of resistant bacteria from animals to humans; that populations of pathogenic and nonpathogenic animal bacteria may act as genetic reservoirs of resistance for important medical pathogens, with close contact between people and companion animals, in addition to food products, providing opportunity for genetic exchange; and, perhaps most importantly from a political perspective, that in many countries around the world the total quantity (gross weight) of antimicrobials used in veterinary medicine is greater than in human medicine 13, 14, has put antimicrobial use in animals at the centre of the public health AMR debate. When combined with the use of antimicrobials for disease prevention at herd or flock level and, in around half of the world's countries, for growth promotion, it is little wonder that antimicrobial use in animals has resulted in sustained political concern over the contribution that veterinarians and the animal sector in general may be making to the growing crisis of antimicrobial resistance in humans, with frequent calls for restriction or even banning of veterinary use of antimicrobials. Despite numerous political recommendations that coordinated, overarching surveillance of AMR is implemented at national and international level 15, 16 there are still relatively few examples of harmonised and integrated surveillance in humans and animals that allow comparison of data. Examples include The National Antimicrobial Resistance Monitoring System (NARMS) in the USA, Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) in Canada, Japanese Veterinary Antimicrobial Resistance Monitoring System (JVARM) in Japan and several European schemes including Danish Integrated Antimicrobial Resistance Monitoring and Research Programme (DANMAP) (Denmark), NORM-VET (Norway), Swedish Veterinary Antimicrobial Resistance Monitoring (SVARM) (Sweden) and NethMap/Monitoring of Antimicrobial Resistance and Antibiotic usage in Animals in the Netherlands (MARAN) (the Netherlands). At EU level, the European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC) monitor AMR in the food chain and food-borne zoonotic pathogens, but not in companion animals. In the absence of sufficient scientific evidence about AMR, in particular the key question of the impact of veterinary antimicrobial use on public health, politicians around the world have faced difficult decisions. In the absence of scientific certainty politicians have adopted the ‘precautionary principle’, allowing preventive action to be taken when there is a possibility of harm but where the scientific evidence is not sufficiently complete to allow full assessment. The result in Europe is a continuing European political focus on banning or restricting veterinary antimicrobial use, especially in the agricultural sector, and reducing the total quantities of antimicrobials used in animals. In the political and regulatory environment in the USA, the precautionary principle has been applied somewhat differently with less political appetite for banning or restricting antimicrobials 9. The first active political engagement with antimicrobial resistance occurred in 1968 in response to growing concerns over multidrug resistant Salmonella in humans and animals, with the establishment of an independent advisory committee by the UK Government chaired by Professor Michael Swann. The Swann Report 17, published in 1969, recommended restriction of the use of antimicrobials as growth promoters, which took 45 years to fully implement in Europe, and establishment of overarching monitoring of AMR in humans and animals, which has still not been implemented globally. Almost 50 years on, this report continues to set the political stage in relation to veterinary antimicrobial use and possible impacts on human health. We would do well not to lose sight of the lessons learned in the decades following its publication, specifically that sensible recommendations based on competent assessment of the available, even if incomplete, scientific evidence should not be sidelined pending collection of conclusive evidence; instead the two should progress in parallel with continuous monitoring and refinement as evidence is gathered. The global political thrust in relation to AMR in the human and animal health sectors continues to be that overuse of antimicrobials is the cause of the problem and that reducing their use is the solution. In Europe, most political effort since 1969 has been directed at the food animal sector through reducing the use of antimicrobials as growth promoters and, more recently, reducing total antimicrobial use. It was not until 2006 that a EU-wide ban on antimicrobial growth promoters was eventually implemented, completing a political process that had started four decades previously with the banning of tetracycline, penicillin and streptomycin for growth promotion in 1974, followed by complete bans of antimicrobial growth promoters in Sweden and Denmark in 1988 and 1994. Denmark also implemented restrictions on veterinary dispensing of antimicrobials; decoupling veterinary prescription of antimicrobials from supply remains on the European political agenda and, if implemented, would have significant impact on veterinary practice business models in many countries. Monitoring, and reducing, antimicrobial use has become a key global political driver. The European Medicines Agency monitors the sales of antimicrobial agents for food producing animals and horses across Europe 18 providing benchmarks against which political targets for reduction are set. In some countries governmental targets for reduction in the sales of veterinary antimicrobials have been agreed with stakeholders. For example, the Netherlands decreased sales of antimicrobials by 49% between 2010 and 2012 with further reduction targets agreed; antimicrobial sales in Scandinavia have been progressively reduced through a series of government–stakeholder agreed targets 18. Nevertheless, the estimated consumption of antimicrobials (corrected for estimated biomass) in animals continues to be greater than in humans across Europe as a whole 6. It is becoming increasingly clear, however, that the concept of overuse as the key driver of AMR may be overly simplistic 19. Antimicrobial resistance is a complex public and animal health issue and there is recognition that integrated strategies across all sectors, backed by political will, stakeholder buy-in and sufficient economic support, are required to control it 1. Although overprescribing of antimicrobials is undoubtedly an important factor, reducing their use in human medicine has not consistently resulted in reduction of resistance for key pathogen–antimicrobial combinations with examples of resistance remaining apparently stable or even increasing despite reduced antimicrobial use. The question of whether phasing out antimicrobials as growth promoters across Europe and the restrictions placed on therapeutic use of antimicrobials in Scandinavia, with associated reductions in quantities used, has resulted in a positive impact on human health continues to be the subject of scientific and political disagreement. Responsible, or ‘prudent’, use of antimicrobials has emerged as a parallel precautionary approach to the control of AMR. Initially, the political focus was on restricting veterinary use of antimicrobials used to treat multidrug resistant human pathogens presenting significant risk to public health. Since 2005 the World Health Organization has published lists of ‘critically important antimicrobials for human medicine’, ranked according their importance with the goal that their use should be restricted in all sectors to preserve their effectiveness 20. This approach has been extended by the World Organisation for Animal Health (OIE) with the publication of a list of antimicrobials of veterinary importance which contains recommendations for restricting the use in food animals of antimicrobials that are critically important for both human and animal health 21. This list includes fluoroquinolones and third- and fourth-generation cephalosporins and forms a rational basis for responsible guidelines worldwide. There are several examples of stakeholder groups at national and international level that have responded to the AMR challenge and shown leadership in producing responsible use guidelines. In the late 1990s the UK veterinary and farming sectors established the RUMA (responsible use of medicines in agriculture) alliance and in 2005 EPRUMA (European platform for responsible use of medicines in animals) was established. Stakeholder groups have now produced a variety of responsible use guidelines for antimicrobials in veterinary practice. Examples include general guidance to veterinary practitioners from the British Veterinary Association (BVA) and the Federation of Veterinarians in Europe (FVE), guidelines on antimicrobial use in companion animal practice from the Federation of European Companion Animal Veterinary Associations (FECAVA), the British Small Animal Veterinary Association (BSAVA), the American Veterinary Medical Association (AVMA) and in equine practice from the British Equine Veterinary Association (BEVA). Widespread adoption of responsible use guidelines in equine practice is an important goal, coupled with accurate recording of use (as, for example, already happens in Scandinavia), that will go some way to addressing political concerns about the prescription of critically important antimicrobials and cascade prescribing by veterinarians, including equine practitioners 22, 23. It is understandable, given the importance of food-borne zoonotic bacteria, that the political lens has thus far been focused mainly on the food animal sector. It is only recently that antimicrobial use in companion animals and horses has received political attention 7, 24 probably because comparatively small quantities (<10% of total quantities sold each year) of antimicrobials are used in these species 18 and because of a public health focus on food-borne pathogens. There are now recommendations that systematic international surveillance of AMR is established for companion animals and horses and a recognition that the close relationship between people and companion animals may provide new opportunities for transfer of resistance to human pathogens 7, 24. Antimicrobial resistance is now a highly important One Health issue with political impact squarely on companion animal and equine veterinary medicine; it is no longer a subject confined to the food animal sector. Antimicrobial resistance is, of course, also important for companion animal and equine health with multidrug resistant pathogens such as meticillin-resistant Staphylococcus aureus (MRSA) causing clinical disease in horses and with evidence of transfer of MRSA between humans and horses 25 and of carriage in horses 26. As would be expected, therapeutic treatment of horses with antimicrobials temporarily increases the prevalence of resistant sentinel Escherichia coli, including multidrug resistance and production of extended spectrum β-lactamases 27, acting as a reminder of the impact of ‘routine’ veterinary therapy on microbial populations. The message is clear that it is time to apply common sense and sound scientific principles to address AMR in equine practice. As a minimum, further surveillance in horses is required, along with universal adoption of responsible use guidelines 28. Irrespective of the scientific uncertainties, AMR is a true One Health issue that is relevant to the equine industry. Whatever the political dimensions of this debate it is essential that the equine veterinary profession and equine industry continue to engage actively with the AMR agenda, promote public and political confidence by demonstrating leadership through responsible use of antimicrobials and monitoring of AMR, and participate in evidence-based practice.

Antimicrobial resistance (AMR) is a worldwide ‘One Health’ problem. The spread of AMR has limited the treatment options against infectious diseases. Inappropriate use of antimicrobials, is a major contributor for the development of AMR and its spread. In animal husbandry, antimicrobials are used for treating infectious diseases and in sub-therapeutic concentrations for growth promotion and disease prophylaxis. The use of antimicrobials in sub-therapeutic concentrations exerts selective pressure on bacteria and results in the emergence of bacterial strains resistant to one or more antimicrobials. The food animals raised on sub-optimal doses of antibiotics become reservoirs of resistant bacterial strains, transmitted subsequently to man and the environment. Various human, animal and environmental health agencies have decided to jointly address this problem. Establishment of integrated and harmonized AMR surveillance programmes, reduced use of antimicrobials in animal production, good governance of veterinary services, and development of new antimicrobials and their alternatives are some of the AMR management strategies in animals. Antibiotics are indispensable for human health; however, they should be totally banned in the food animals to preserve effectiveness of these drugs. In India, use of antimicrobials in food animals is limited for disease prophylaxis and growth promotion. However, absence of uniform regulations on the use of antimicrobials in animal production threatens the rationale use of these drugs in livestock.

Antimicrobial resistance (AMR) is a growing global health crisis that threatens public health, food security, and economic sustainability. The widespread and often inappropriate antimicrobial use (AMU) in livestock plays an important role in the development of AMR. This thesis employed a multidisciplinary approach across five empirical studies to evaluate AMU and AMR within diverse Ethiopian livestock systems, and to develop evidence-based interventions that promote prudent AMU and mitigate AMR risks in resource‑limited settings. The first study (Chapter 2) explored veterinary medicinal product usage and pharmacy practices. It revealed widespread misuse, poor storage, and dispense of prescription-only antimicrobials by untrained personnel or informal vendors without prescriptions. Farmers use the same antimicrobials for various diseases, administer them without professional consultation, and use improper dosing; 43% reported no clinical improvement following antibiotic use, underscoring the consequences of poor practices. Chapter 3 assessed farmers’ disease management practices and their knowledge, attitudes, and behaviors (KAB) regarding AMU, residues, and AMR. Results showed extensive AMU practices with large proportions of farmers exhibited poor knowledge (94%) and unfavorable attitudes (97%). On the other hand, 80% of the farmers showed good behavioral scores. Negative AMU behavior was strongly associated with higher education, multi‑species farming, and frequent disease occurrence, reflecting the complex socio‑ecological drivers of AMU behavior. Chapter 4 analyzed a large database of 12,438 veterinary clinical case records to evaluate antimicrobial prescribing practices and adherence to stewardship principles. Findings showed that 75% of all prescriptions were antimicrobials, mainly oxytetracycline and penicillin-streptomycin (penstrep). Almost all prescriptions (97%) lacked a laboratory confirmed diagnosis, and a substantial proportion was prescribed for presumed viral and other non-bacterial conditions, resulting in 19% non-prudent use. These inappropriate prescribing practices were linked to specific clinics, clinical signs, and viral infections, emphasizing the urgent need for improved diagnostics and stewardship in veterinary care. Chapter 5 examined the contribution of AMU to resistance in Escherichia coli isolates from 83 dairy farms. This study confirmed widespread use of oxytetracycline, penstrep, sulfonamides, and penicillin. Isolates exhibited high resistance to tetracycline (65%), streptomycin (56%), and sulfisoxazole (43%), including resistance to cephalosporins and fluoroquinolones. Nearly half of the isolates (46.5%) were multidrug resistant, with AMU history and geographic location identified as key drivers, necessitating locally tailored stewardship interventions. In Chapter 6, a smartphone‑based application, “EDDiE,” was developed and evaluated to support small ruminant disease diagnosis and prudent antimicrobial use, based on 2,687 cases. The app demonstrated moderate diagnostic agreement with clinicians (62.3%) and substantially improved prudent prescription of antimicrobials, with only 3.1% of the cases classified as non‑prudent. Prescribing practices varied significantly across agroecological zones and regions and aligned with the national guidelines. However, antibiotic prescribing practices for viral diseases in those guidelines are inconstant with the WOAH recommendations on AMU, revealing gaps in alignment with international stewardship standards. Overall, this thesis provides robust evidence, practical interventions, and digital innovations to support veterinary decision‑making in resource-limited settings. The results emphasize the urgent need for antimicrobial stewardship to safeguard animal health, productivity, and public health. By harnessing digital tools like EDDiE and integrating One Health strategies, Ethiopia can strengthen prudent AMU, contain AMR, and contribute to sustainable livestock production.

ObjectiveTo identify and describe government policy targeting veterinary antimicrobial use and antimicrobial resistance in production animals globally and to map these interventions to identify evidence gaps.MethodsWe searched MEDLINE, CAB s, Web of Science and ProQuest Dissertations and Theses Global databases from inception to April 2025 for studies that quantitatively assessed the impact of government-enacted policy interventions by measuring the change in antimicrobial use (for example, mg/kg biomass, mg of active ingredient or defined daily doses for animals) or antimicrobial resistance in production animals or humans. Two reviewers independently completed screening, data extraction and risk-of-bias assessment for identified studies.FindingsWe identified 40 policy evaluations, all originating from the World Health Organization (WHO) Region of the Americas, European Region or Western Pacific Region. No eligible studies from other WHO regions were identified. Most studies (35/40) evaluated legislative or regulatory interventions and 26 were primarily bans or restrictions on specific antimicrobial uses. Most (34/40) articles reported decreases in antimicrobial use in animals or in antimicrobial resistance in animals or humans that were associated with policy implementation. However, the studies were methodologically heterogeneous and had a high risk of bias.ConclusionThis systematic review and evidence map fill an important gap in knowledge supporting evidence-informed action on antimicrobial resistance. However, we identified relatively few quantitative evaluations of government policies targeting veterinary antimicrobial use or resistance, which highlights the need for additional, methodologically robust, policy evaluations.

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

This article has no abstract.

INTRODUCTION: Antimicrobial resistance is one of the topical issues that is part of the “One Health” concept with implications for animal health, human health, and even environmental “health”. At the European Commission (EC) level, legislation has been issued for the monitoring of antimicrobial resistance and these rules are applicable by each Member State (MS). For the proper implementation of the above legislation, audits are carried out in Member States that have developed programs on antimicrobial resistance that go beyond the EC's requests.OBJECTIVES: The aim of the study was the analysis of existing data reports, legislation and recommendations on antimicrobial resistance through which surveillance and monitoring is carried out in the European Union (EU). METHODS: The audit reports issued between 2015 and 2017 by the Food Veterinary Office (FVO), as well as the articles and studies issued by the EC through the antimicrobial resistance institutes were analysed.RESULTS: The FVO conducted audits to “evaluate the monitoring and reporting of antimicrobial resistance in zoonotic and commensal bacteria in certain food-producing animal populations and food” in 12 MS, and audits to “gather information on the prudent use of antimicrobials in animals” in 8 MS. These are countries that have very well implemented the EC's requests and included the “One Health” perspective in antimicrobial resistance programs. Some Member States have risk management strategies for reducing antimicrobial resistance for more than 20 years. They have carried out research projects on antimicrobial resistance. There is an action plan on antimicrobial resistance at the EC level, but their implementation and understanding up to the level of all actors involved in this issue varies from MS to MS. Antimicrobial resistance in the animal population is a topical issue, notoriety among the actors involved, as well as an interdisciplinary problem with indirect results. The same principle of antimicrobial resistance in animals is applicable to humans and the environment as such, this problem can be embedded in the concept of “One Health”. The overall objective of the MS is to generate knowledge and tools to “combat” antimicrobial resistance in animals, humans and even the environment.CONCLUSION: As a conclusion, in order to improve and optimize antimicrobial resistance programs, a “good practice guide” can be achieved by MS with extensive experience in this area, to be used by MS with a more precarious application and over time to harmonize antimicrobial resistance programs within the EU.

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.

Data on antimicrobial use in livestock: Lessons from Uganda

In dairy intensification, mastitis infections become prevalent and induce frequent Antimicrobial Use (AMU), sometimes inappropriately. This poses public health risks because of growing Antimicrobial Resistance (AMR), which calls for stewardship programs informed by Knowledge, Attitude and Practices (KAPs) about AMU and AMR to halt or reverse the worrying trend. Data was obtained in cross sectional survey conducted in four peri-urban wards around Nakuru city in Kenya. Randomly selected sample farmers (n=124) with free-grazing, semi-zero-grazing or zero-grazing dairy management, representing increasing dairy intensification levels provided data on the KAPs. Chi-square test statistics was fitted to establish associations between KAPs and dairy intensification levels. Among the sample farmers, six in ten (58.8 percent) had intensified dairy production, at least six in ten were marketing milk through informal outlets and were using antimicrobial drugs. Compliance with the withdrawal period was high and increased (p&amp;lt;0.05) with increasing intensification from free-grazing to zero-grazing. Within antibiotic withdrawal period, at least seven in ten farmers did not sell milk, fewer than four in ten consumed their milk at home and fewer than three in ten fed the milk to calves. Though independent of dairy intensification level (p&amp;gt;0.05), using antimicrobials for mastitis treatment increased while sourcing information on antimicrobial use from extension and veterinary officers decreased, with increasing intensification level. Farmers with some training on prudent antimicrobial use and with positive attitudes that milk from antimicrobial treated cows is unsafe, antimicrobial resistant pathogens and residues can be passed from milk to humans, mastitis can be treated without antimicrobial drugs, and antimicrobial residues can end up accumulating in the soils increased (p&amp;gt;0.05) with increasing dairy intensification levels. These results show that regarding AMU and AMR, farmers become more knowledgeable, with positive attitudes and good practices as they intensify their dairy management. The implication is that intensification of dairy management motivates farmers to gain more knowledge, acquire positive attitudes and apply good practices towards responsible prudent use of antimicrobials in livestock. Therefore, strengthening stewardship with targeted training and sensitization can foster prudent and responsible antimicrobial use.

Surveillance of antimicrobial use and antimicrobial resistance is a critical component of the “Global Action Plan” to tackle antimicrobial resistance. However, there is a paucity of such surveillance in communal farming areas in South Africa. This study investigated knowledge and antimicrobial use practices by cattle farmers and antimicrobial resistance levels of indicator bacteria in cattle in a rural communal farming area in South Africa. Seventy (70) farmers were interviewed at five cattle inspection sites using structured questionnaires. Rectal swabs were collected from apparently healthy cattle (n = 100) for culture of Escherichia coli and Enterococcus species, and antimicrobial susceptibility testing using broth microdilution. The farmers indicated predominantly using tetracyclines. Although 42% of the farmers indicated hearing about antimicrobial resistance, none of them clearly understood what it involves. Seventy‐nine (79) E. coli and 71 Enterococcus species were isolated with E. faecium being the dominant species among the Enterococcus isolates. E. coli isolates were resistant to colistin (16%; 13/79), chlortetracycline (8%; 6/79) and amoxicillin (8%; 6/79). Enterococcus isolates were resistant to enrofloxacin (55%; 39/71) and amoxycillin (3%; 2/71). We observed knowledge gaps in prudent antimicrobial use practices and antimicrobial resistance among the farmers. Farmer tailored education programmes on primary animal health care and prudent antimicrobial use practices must be developed and implemented to improve antimicrobial stewardship among farmers with limited veterinary supervision. The level of colistin resistance detected among E. coli isolates from rural communal cattle in this study was unexpected and warrants further molecular investigation to check if the resistance is plasmid mediated.

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.

Inappropriate use of antimicrobials is perhaps one of the most threatening forms of wasteful clinical care. This is because inappropriate use of antimicrobials encourages the development of antimicrobial resistance (AMR). This chapter builds on available evidence to present a comprehensive set of policy actions to promote an effective use of antimicrobials. The chapter is divided into five sections. The first section analyses trends in consumption and estimates the share of inappropriate use of antimicrobials in OECD countries. This is followed by an assessment of the current and future health and economic burden caused by inappropriate use of antimicrobials and AMR. Section three spells out the main determinants underlying inappropriate antimicrobial use. Section four assesses the potential effectiveness of policy actions to promote an effective use of antimicrobials. Special emphasis is devoted to education and information activities; to organisational changes; and to a broader use of new technologies. A final section summarises the key policy implications of the chapter.

BackgroundInappropriate antimicrobial use (AMU) is a key modifiable factor that leads to the development of antimicrobial resistance (AMR). The objectives of this study were to determine the following among Tennessee beef cattle producers: (1) the opinions on factors driving AMU (2) opinions on alternatives to antimicrobials, (3) the knowledge and perceptions regarding AMU and AMR, and (4) the preferred avenues for receiving information on prudent AMU. A survey questionnaire was made available to participants both in print and online from January 26, 2018 through May 11, 2018. The questions targeted the producers’ demographics and their AMU practices; factors driving producer’s choice of antimicrobials; perceptions, opinions and concerns about AMU and AMR in cattle production. Ordinal logistic regression was used to test for associations between the captured demographic information and producers’ degree of concern about AMR.ResultsOverall, 231 beef producers responded to all or some of the survey questions. More than 60% of the participants mentioned that they kept up-to-date written records on antimicrobial purchases and AMU. Regarding extra-label use, 169 (84.1%) of the 201 respondents did not practice extra-label AMU. Profitability of the beef operation was a key factor influencing the decisions of many producers to use antimicrobials for disease management and prevention on their farms. Of the 228 producers who completed the question on the rating of their degree of concern about AMR, 50 (21.9%) reported that they were very concerned about AMR, 133 (58.3%) were moderately concerned, and 36 (15.8%) reported that they were not concerned about AMR. Nine producers (4%) did not rate their degree of concern about AMR because they were not familiar with what antimicrobial resistance meant. The inferential analyses suggested that younger beef producers were significantly less concerned about AMR when compared to the older ones (P = 0.019). Regarding avenues for receiving information on prudent AMU, no single medium was most preferred by all the respondents.ConclusionsThere is a need to promote the use of written antimicrobial treatment protocols among beef producers in Tennessee. Continued training for beef producers on infection prevention and control and prudent AMU is needed.