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Antibiotics
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The One Health Action Plan Against Antimicrobial Resistance
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The One Health Action Plan Against Antimicrobial Resistance

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (28 February 2026) | Viewed by 12614

Special Issue Editor

Dr. Anna Maria Spagnolo

E-Mail Website
Guest Editor
Dipartimento di Scienze della salute (DISSAL), Università degli Studi di Genova, 16126 Genova, GE, Italy
Interests: healthcare environment; emerging pathogens; healthcare-associated infections; antimicrobial resistance; infection prevention and control
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Antibiotic resistance is recognized as a major public health problem in Europe and worldwide. Because antibiotic-resistant microorganisms and resistance genes circulate within and between ecosystems, prevention and control of antibiotic resistance requires integrated actions at the human–animal–environment interface. In 2015, the WHO Member States unanimously endorsed a Global Plan of Action to address antimicrobial resistance, and the WHO called on all countries to take concerted action across all sectors of human activity, with a One Health approach, bringing together stakeholders from relevant sectors to communicate and work together in the design, implementation, and monitoring of programs, policies, legislation, and research to mitigate AMR and achieve better health and economic outcomes.

The actions envisaged in the European One Health action plan include incentives to consider the environment as a factor that can contribute to the spread of AMR and guidance aimed at filling knowledge gaps on antimicrobial resistance in the environment.

Furthermore, evidence suggests that changes occurring in the natural environment due to the climate crisis are increasing the spread of infectious disease.

An increase in extreme weather events and natural disasters such as storms, heatwaves, hurricanes, typhoons, floods, and forest fires can cause population displacement, which can facilitate the spread of drug-resistant infections and disease. In addition, increased prevalence of disease could result in an increase in the improper use of antimicrobial drugs, which could further exacerbate antimicrobial resistance.

By uniting findings from a variety of fields, including human and veterinary medicine, ecology, and others, it is possible to gain an overview of how antibiotic resistance develops and spreads, thus bringing together knowledge from different areas to attempt to control it.

This Special Issue seeks research papers on various aspects related to the spread of antibiotic-resistant microorganisms and resistance genes in a healthcare setting, the veterinary field, and the environment; food contamination; surveillance, prevention, and control of infections; appropriate use and surveillance of antibiotic consumption use in human and veterinary settings; and climate change and antibiotic resistance.

We encourage the submission of interdisciplinary work and multi-country collaborative research. We welcome original research papers using different study designs as well as literature reviews, systematic reviews, and meta-analyses.

Dr. Anna Maria Spagnolo
Guest Editor

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.

Keywords

  • one health approach
  • antimicrobial resistance
  • healthcare-associated infections
  • food contamination
  • environment and antibiotic resistance
  • surveillance
  • prevention and control

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Published Papers (5 papers)

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Research

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24 pages, 924 KB  
Article
Antimicrobial Consumption and Utilisation in Zambia: Results from the Analysis of National Data for the Human and Animal Health Sectors
by Steward Mudenda, Joseph Yamweka Chizimu, Victor Daka, Maisa Kasanga, Webrod Mufwambi, Kelvin Mwangilwa, Jimmy Hangoma, Priscilla Gardner, Chikwanda Chileshe, Ntombi B. Mudenda, Taona Sinyawa, Amon Siame, Mwendalubi Hadunka, Fred Mulako Simwinji, Kaunda Kaunda, Mpela Chibi, Zoran Muhimba, Elimas Jere, Makomani Siyanga, Peter Lisulo, Freddie Masaninga, Samson Mukale, Andrew Bambala, Misheck Shawa, Charles Chileshe, Bertha Chibwe, Mercy Mukuma, Bruno S. J. Phiri, Geoffrey Mainda, Yasuhiko Suzuki, Fusya Goma, John Bwalya Muma and Roma Chilengiadd Show full author list remove Hide full author list
Antibiotics 2025, 14(11), 1126; https://doi.org/10.3390/antibiotics14111126 - 7 Nov 2025
Viewed by 1790
Abstract
Background/Objectives: Antimicrobial Resistance (AMR) remains a growing public health threat, underscoring the need for robust surveillance of Antimicrobial Consumption (AMC) and Antimicrobial Use (AMU). This study analysed AMC and AMU trends in Zambia’s human and animal health sectors, identifying priority areas for antimicrobial [...] Read more.
Background/Objectives: Antimicrobial Resistance (AMR) remains a growing public health threat, underscoring the need for robust surveillance of Antimicrobial Consumption (AMC) and Antimicrobial Use (AMU). This study analysed AMC and AMU trends in Zambia’s human and animal health sectors, identifying priority areas for antimicrobial stewardship (AMS) under a One Health framework. Methods: A retrospective study was conducted in February 2025, utilising data from 2018 to 2023. Sources of data included the Zambia Medicines Regulatory Authority (ZAMRA) and the WOAH Animal Antimicrobial Use (ANIMUSE) Global Database platform. AMC was analysed using the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) methodology. Antimicrobials were classified using the WHO Anatomical Therapeutic Chemical (ATC) system, and consumption was measured in Defined Daily Doses (DDDs) per 1000 inhabitants per day (DID). Antibiotics were further categorised using the WHO Access, Watch, and Reserve (AwaRe) classification. Data analysis was performed using IBM SPPS version 25.0. Results: In the human health sector, oral antibiotics accounted for 88% of total consumption. Penicillins (33%), cephalosporins (19.2%), and macrolides (12.4%) were the most consumed classes. In 2023, 98,651,882.42 DDDs per 1000 inhabitants/day were recorded, with amoxicillin, ceftriaxone, and sulfamethoxazole/trimethoprim leading as the most consumed antibiotics. According to the consumption of antibiotics by the WHO AwaRe classification, 47% were Access, 40% Watch, and 3% Reserve group antibiotics. In animal health, tetracyclines dominated (63%), followed by sulphonamides (26%) and penicillins (11%). AMU in animal health peaked in 2023. Conclusions: This study found high AMC and AMU, especially Watch-group antibiotics and tetracyclines, highlighting the need for strengthened antimicrobial stewardship, regulatory oversight, and integrated One Health surveillance to mitigate AMR risks in Zambia. Full article
(This article belongs to the Special Issue The One Health Action Plan Against Antimicrobial Resistance)
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13 pages, 1184 KB  
Article
Tourism and the Global Vectoring of Antimicrobial-Resistant Disease: What Countries Are Most Impacted?
by Peter Collignon and John J. Beggs
Antibiotics 2025, 14(11), 1055; https://doi.org/10.3390/antibiotics14111055 - 22 Oct 2025
Cited by 2 | Viewed by 2107
Abstract
Background: Tourists returning home and visitors from abroad often carry antimicrobial-resistant (AMR) bacteria. Many of these resistant bacteria are acquired from, or were spread via, the environment (especially water). Understanding the impact from acquiring resistant bacteria via tourism upon global antimicrobial resistance is [...] Read more.
Background: Tourists returning home and visitors from abroad often carry antimicrobial-resistant (AMR) bacteria. Many of these resistant bacteria are acquired from, or were spread via, the environment (especially water). Understanding the impact from acquiring resistant bacteria via tourism upon global antimicrobial resistance is limited. Methods: Traveller transmission of AMR bacteria can be estimated from combining the numbers of travellers with AMR bacteria rates in different regions and the prevalence of communicable diseases. We used resistance data (WHO and contemporary publications) to measure the prevalence of E.coli resistance to third-generation cephalosporins. The study uses data from 2019, the year with the most complete dataset that also predates disruptions to travel caused by the COVID-19 pandemic. We then used the global burden of disease study and travel data from the World Travel and Tourism to create regional and country level indices measuring the impact of AMR bacteria for 241 countries. Estimates of global travel patterns were obtained using a gravity-style trip distribution model. Findings: Regions with the highest impact of AMR bacteria from returning travellers were Northern Europe and Western Europe. The region with the highest impact of AMR bacteria from visiting travellers was the Caribbean where small island countries receive large numbers of visitors. For countries/administrative regions with populations greater than 5 million, the AMR bacterial travel impacts measured in decreasing risk order from the highest were Hong Kong, Denmark, New Zealand, Hungary, Norway and Sweden. Interpretation: For some countries the incidence of AMR infection among both visitors and returning travellers is much higher than in the domestic population. This impact and how these bacteria are acquired from the environment, must be factored into public health policies for containing global spread of AMR bacteria and as part of a One Health approach. Full article
(This article belongs to the Special Issue The One Health Action Plan Against Antimicrobial Resistance)
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Review

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26 pages, 393 KB  
Review
Antimicrobial Resistance Along the Food Chain: Spread and Integrated Strategies for Mitigation and Control
by Anna Maria Spagnolo, Francesco Palma, Giulia Amagliani, Michele Fernando Panunzio, Maria Teresa Montagna, Elena Alonzo, Guglielmo Bonaccorsi, Giulia Cairella, Emilia Guberti and Giuditta Fiorella Schiavano
Antibiotics 2026, 15(3), 311; https://doi.org/10.3390/antibiotics15030311 - 19 Mar 2026
Viewed by 1394
Abstract
The development of antimicrobial resistance (AMR) and the emergence of multiresistant pathogens represent a growing global threat to both human and animal health. Beyond the excessive and improper use of antimicrobials in human medicine, irrational use in veterinary medicine, agriculture, and aquaculture significantly [...] Read more.
The development of antimicrobial resistance (AMR) and the emergence of multiresistant pathogens represent a growing global threat to both human and animal health. Beyond the excessive and improper use of antimicrobials in human medicine, irrational use in veterinary medicine, agriculture, and aquaculture significantly contributes to the selection and spread of resistant microorganisms, which can enter the food chain and reach humans through food consumption or handling. Based on results from a recent meta-analysis, the prevalence of antimicrobial-resistant foodborne pathogens in food samples exceeds 10%. The veterinary sector is of particular concern, as a large proportion of antimicrobials are used in animal production, generating strong selective pressure and favoring the dissemination of AMR along the food chain. In an increasingly interconnected global context, resistant pathogens and resistance determinants can disseminate rapidly across sectors and national borders, making strategies confined to a single sector insufficient; therefore, effectively addressing AMR requires a One Health approach encompassing the human, veterinary, and environmental domains. Key mitigation strategies include strengthening antimicrobial stewardship programs, also in animal production, reducing routine prophylactic use of antimicrobials, and improving surveillance, coordinated across sectors and, where possible, further supported by advanced technologies such as artificial intelligence and machine learning. Further efforts are also needed to improve microbiological diagnostics, particularly through rapid and molecular methods, to support timely, targeted therapies and reduce inappropriate empirical treatments. In parallel, investment in new therapeutic options, including innovative molecules, drug combinations, and alternative approaches, remains crucial to effectively countering the growing burden of antimicrobial resistance. Full article
(This article belongs to the Special Issue The One Health Action Plan Against Antimicrobial Resistance)
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14 pages, 471 KB  
Review
Antimicrobial Resistance: How Can We Overcome the Problem?
by Valerio Massimo Sora, Clementine Wallet, Gabriele Meroni, Thomas Loustau, Olivier Rohr, Alfonso Zecconi and Christian Schwartz
Antibiotics 2026, 15(1), 82; https://doi.org/10.3390/antibiotics15010082 - 14 Jan 2026
Viewed by 1693
Abstract
Antimicrobials are common drugs used to treat and prevent infectious diseases in plants, animals, and humans. Since their discovery in the mid-20th century, their use has dramatically increased for the benefit of humanity, and also for animal care. However, antimicrobial resistance soon appeared, [...] Read more.
Antimicrobials are common drugs used to treat and prevent infectious diseases in plants, animals, and humans. Since their discovery in the mid-20th century, their use has dramatically increased for the benefit of humanity, and also for animal care. However, antimicrobial resistance soon appeared, which, according to the WHO, will limit or impede their use at the horizon of 2050. Indeed, antimicrobial resistance (AMR), which is a natural phenomenon in bacteria increased dramatically over the last 3 decades mainly due to the overuse and misuse of antibiotics in humans, animals, and plants. Apart from affecting human health, drug-resistant diseases also adversely affect plant and animal health, reduce agricultural productivity, and threaten food security. AMR affects all countries, regardless of economic status, and imposes high costs on health systems and national economies. Therefore, antimicrobial resistance should be studied and analyzed under the One Health paradigm. In mind of the One Health paradigm, to reduce and overcome AMR, we must take at least 3 complementary and integrated actions: (i) monitoring the resistome; (ii) developing protective strategies against antibiotic resistance; (iii) taking curative actions by designing new and original treatments. Moreover, the three actions must be conducted simultaneously due to the continuous adaptation of bacteria. Full article
(This article belongs to the Special Issue The One Health Action Plan Against Antimicrobial Resistance)
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20 pages, 878 KB  
Review
Challenges and Current Trends in Preventing Antimicrobial Resistance in EU Water Law Context
by Justyna Rogowska, Grażyna Gałęzowska and Agnieszka Zimmermann
Antibiotics 2025, 14(1), 18; https://doi.org/10.3390/antibiotics14010018 - 31 Dec 2024
Cited by 8 | Viewed by 3977
Abstract
The increasing consumption of pharmaceuticals, including antibiotics, and their improper disposal have resulted in both pharmaceuticals and their metabolites being released into the environment, where they pose a risk to both ecosystems and human health. One of the most serious threats to public [...] Read more.
The increasing consumption of pharmaceuticals, including antibiotics, and their improper disposal have resulted in both pharmaceuticals and their metabolites being released into the environment, where they pose a risk to both ecosystems and human health. One of the most serious threats to public health associated with the presence of antibiotics in the environment is antimicrobial resistance (AMR). In order to combat AMR, the legal aspect of water protection becomes a critical area of action. This article analyzes the current challenges and legislative developments in the European Union (EU) aimed at mitigating pharmaceutical contamination in aquatic environments, particularly with regard to AMR. It traces the evolution of EU water protection policies from the initial surface and groundwater directives to the recent updates of the Water Framework Directive, Groundwater Directive and Environmental Quality Standards Directive, focusing on the integration of pharmaceutical contaminants into the regulatory framework. In addition, these changes include the update of the Watch List system for monitoring emerging contaminants, the adoption of effects-based methods (EBMs) in the assessment of water status and the streamlining of the legislative process to respond more quickly to emerging threats in the aquatic environment. The EU’s strategic approach to pharmaceuticals in the environment is emphasized as a key framework for harmonizing the environmental standards and addressing the problem of AMR through more sustainable pharmaceutical practices. This study advocates for a proactive, integrated approach to water policy that aligns regulatory actions with scientific advancements to protect public health and ecosystem integrity. Full article
(This article belongs to the Special Issue The One Health Action Plan Against Antimicrobial Resistance)
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