The Global Antibiotic Imperative: Bridging Access, Stewardship, and Innovation

Dear Colleagues,

Antimicrobial resistance (AMR) is no longer a "silent pandemic"; it is a definitive crisis of modern medicine that threatens to undo a century of medical progress. As we approach 2050—a year projected to see 10 million annual deaths due to resistant infections—the global community faces a complex "Antibiotic Imperative."

This Special Issue explores the critical interplay between the three pillars of the AMR response.

Access: Currently, more people die from a lack of access to antibiotics than from resistant infections. Bridging the gap in Low- and Middle-Income Countries (LMICs) through sustainable procurement and equitable distribution remains a primary moral and clinical goal. Another problem in LMICs is the procurement of antimicrobials at the hospital level. Often, the problem is the system itself, which forces patients to buy Watch or Reserve antibiotics at pharmacies themselves.

Stewardship: Protecting the efficacy of current and future antibiotics requires "access without excess", utilizing rapid diagnostics, One Health surveillance, and behavioral interventions to ensure that the right drug reaches the right patient at the right time. The use of antimicrobials at the human and veterinary/agricultural levels should be analyzed from different perspectives in terms of AMR. Furthermore, one of the main reasons for the inappropriate use of antimicrobials is that any antibiotic can be easily found without a prescription at any pharmacy. Therefore, antibiotic use needs strict regulation. The availability of current guidelines for major infectious diseases, adherence to these guidelines, how antimicrobial prophylaxis is managed in hospitals, etc., should also be considered.

Innovation: With the traditional antibiotic pipeline stagnating, there is an urgent need for "breakthrough" rather than "incremental" innovation. This includes AI-driven drug discovery, bacteriophage therapies, and novel non-traditional agents. Additionally, there is a gap between microbiology data and their use in mapping resistance patterns at the country or regional level and adjusting empiric treatments.

By bringing together original research, systematic reviews, and policy analyses, this Special Issue aims to provide a comprehensive roadmap for balancing these often-competing priorities. We invite contributors to submit work that addresses the scientific, economic, and systemic barriers to a sustainable antibiotic future.

Dr. Sezer Okay
Dr. Aslihan Kurt Kizildogan
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

• antimicrobial resistance (AMR)
• antibiotic stewardship (AMS)
• global health equity
• One Health approach
• drug discovery pipeline
• point-of-care diagnostics
• sustainable access
• LMIC health systems
• public–private partnerships
• pathogen surveillance.