Implementation of AMS programs at Habib Medical Group (HMG) healthcare facilities resulted in reduced antimicrobial use and cost, and lowered incidence of HAIs.

The implementation of the AMS program significantly reduced the consumption of broad-spectrum antibiotics, with average daily defined doses (DDDs) dropping from 320 to 233 per 1,000 patient days post-intervention.

Antimicrobial expenditures decreased by 28.45% in the first year of AMS implementation, leading to cumulative cost savings of over S.R. 6.2 million.

The incidence of healthcare-associated infections (HAIs) including C. difficile, ventilator-associated pneumonia (VAP), and central line-associated bloodstream infections (CLABSI) declined markedly after AMS was established.

A large-scale, multi-hospital pre-post study design demonstrated the real-world effectiveness of AMS interventions, reinforcing the value of AMS in improving clinical and economic outcomes in tertiary healthcare settings.

Appropriate antimicrobial selection increased from 32% to 90%.

The cure rate increased from 55% to 91%.

The clinical failure rate decreased from 31% to 5%.

Prevalence of resistant pathogens decreased from 9% to 1%.

Decreased total antimicrobial consumption by 23%.

Decreased targeted antimicrobial consumption by 54%.

The incidence of Clostridium difficile infection decreased by 60%.

The introduced AMS interventions contributed to a reduction in the use of several broad-spectrum antibiotics and reversed the trends of increasing the use of other antibiotics.

AMS interventions were associated with a significant reduction in carbapenem-resistant Acinetobacter baumannii.

Significant reductions in the use of several broad-spectrum antibiotics were observed following AMS program implementation, including imipenem/cilastatin, vancomycin, colistin, and third-generation cephalosporins (P < 0.001 for most).

Trends of increasing use for certain antibiotics, such as piperacillin/tazobactam, were halted after the AMS program introduction, indicating effective intervention in prescribing behaviour.

AMS program implementation significantly reduced carbapenem-resistant Acinetobacter baumannii (CRAb) levels (P = 0.0237), demonstrating impact beyond prescribing metrics.

Changes in antibiotic usage slope post-intervention—for agents like ertapenem and ciprofloxacin—reflect sustained improvements in AMS over time.

After the intervention, there was a 24% reduction in the rate of antibiotic prescriptions (640 vs. 400 prescriptions/1000 admissions)

The incidence of inappropriate antibiotic use was significantly reduced—p = 0.001 (42% vs. 20%)

Significant reductions in the incidence of infections due to methicillin-resistant, S. aureus (48% vs. 33.5%), ESBL-producing E. coli—p = 0.001 (33% vs. 21%), ESBL-producing Klebsiella pneumoniae (30% vs. 20%), and third-generation cephalosporin-resistant Acinetobacter baumannii (27% vs. 19%) were also observed. Total cost savings were US$32,231 during the study period.

There was a 19.6% decrease in volume with a cost reduction of 35% of the pharmacy’s antibiotic budget.

There was a concomitant increase in laboratory tests driven by requests for procalcitonin.

There was no difference in inpatient mortality or 30-day readmission rate during the control and intervention periods.

Following the implementation of AMS ward rounds, adherence to local guidelines significantly improved across several parameters: the selection of antimicrobial agents increased from 34.5% to 61.0% (P < 0.0005), correct dosage from 15.2% to 36.5% (P < 0.0005), and appropriate duration from 13.2% to 31.0% (P < 0.0005).

Microbiological samples were sent for 79.7% of patients (247/310), and clinical improvement by Day 3 was observed in 92.3% of patients (286/310).

Additionally, the use of ceftriaxone was significantly reduced from 51.3% to 14.2% (P < 0.0005).

A reduction in the misuse of antibiotics, leading to better clinical outcomes for patients.

Identified eight specific drug-related problems associated with improper antibiotic use, including excessive duration of therapy and failure to follow culture sensitivity reports.

Significant cost savings due to reduced unnecessary therapy and shorter hospital stays.

The rates of AMR were lower in tertiary care hospitals with effective AMS programs compared to smaller hospitals.

AMS programs are essential for improving patient outcomes, reducing healthcare costs, and minimizing the risk of AMR.

Implementation of AMS programs led to a significant reduction in AMR and HAIs.

AMS programmes in hospitals significantly reduce the incidence of infections and colonisation with MDR organisms, including a 51% reduction in MDR Gram-negative bacteria, 48% in ESBL-producers, 37% in MRSA, and 32% in Clostridioides difficile infections.

The effectiveness of AMS is enhanced when combined with IPC measures, particularly hand hygiene interventions underscoring the synergistic role of AMS and IPC in combating AMR in hospital settings.

AMS programs were associated with decreased antibiotic consumption and lower infection rates from resistant pathogens.

AMS programs significantly reduced total antimicrobial consumption by 19.1%, with even greater reductions observed in ICU settings (39.5%), along with decreased use of restricted and broad-spectrum antibiotics, and a 33.9% reduction in overall antimicrobial costs.

Implementation of AMS led to reduced hospital length of stay (−8.9%) and lowered infection rates from key resistant pathogens such as MRSA, imipenem-resistant P. aeruginosa, and ESBL-producing Klebsiella spp., without increasing mortality or infection-related adverse outcomes.

These findings highlight AMS as an effective hospital-based intervention to curb AMR while improving clinical efficiency and reducing healthcare costs, particularly in high-risk settings like ICUs.

Proper AMS programs reduce the length of stay, AMU, and AMR while improving clinical outcomes.

Implementation of AMS objectives such as guideline-adherent empirical therapy, de-escalation, IV-to-oral switch, and use of restricted antibiotics, was significantly associated with reduced mortality and improved treatment outcomes (e.g., 35% mortality reduction with guideline-adherent therapy and 56% with de-escalation).

Despite moderate to high heterogeneity and generally low-quality evidence across studies, several AMS strategies consistently showed measurable positive impacts, guiding for prioritizing interventions in hospital settings.

Limited or no evidence was found for some AMS objectives (e.g., therapy discontinuation based on lack of infection evidence, renal dosing adjustments), and none were reported for long-term care facilities, highlighting areas for further research and implementation.

A comprehensive literature review yielded seven core elements and 29 checklist items relevant to hospital AMS programmes based on 48 references.

A consensus process involving 15 experts from 13 countries across six continents confirmed the relevance of all seven core elements and 29 items (including one newly proposed), with ≥80% agreement and 20 items rephrased for clarity.

The finalized elements are applicable across both high- and LMICs, providing a foundational framework for national AMS guideline development and hospital-level implementation worldwide.

Healthcare professionals recognize the importance of AMS programs but need more institutional support and training.

Hospital AMS programs have significant value with beneficial clinical and economic impacts.

National AMS programs contribute to rational antibiotic use and better clinical governance in healthcare settings.

AMS programs are essential to combat global AMR trends and must be integrated into national health strategies.

AMR is a complex, global challenge driven by human behaviour across all levels of society, with consequences that impact every individual worldwide.

Despite extensive knowledge and documentation of AMR causes and solutions, coordinated political action both nationally and globally, remains insufficient.

Antibiotics are essential for modern medicine, enabling safe surgery, cancer chemotherapy, organ transplants, and neonatal care; their loss threatens major medical advancements.

Without immediate and coordinated global action, the world risks severe medical, social, and economic setbacks, underscoring the urgency of implementing comprehensive AMS strategies.

AMS programs are essential in combating AMR by promoting rational antibiotic use, improving patient outcomes, and reducing healthcare costs.

Despite challenges such as limited resources, lack of awareness, and resistance to change, AMS programs can be strengthened through the integration of technologies like clinical decision support systems, real-time surveillance, and tailored interventions across diverse healthcare settings.

Adopting a One Health approach, enhancing education and training, and fostering global collaboration and research are key strategies for ensuring the long-term sustainability and effectiveness of stewardship efforts in mitigating AMR.

Most healthcare professionals (97%) acknowledged AMR as a problem in South African hospitals, with 81% expressing willingness to engage in AMS initiatives, reflecting readiness for AMS implementation.

The situational analysis highlighted existing AMS strengths, including the presence of AMS committees and access to supportive information and technology systems at facilities.

Despite infrastructure, actual AMS activity levels and healthcare professional participation were low, indicating the need for strategies to improve engagement and operationalize AMS plans.

Conducting a pre-implementation phase allowed for the identification of systemic gaps, providing a critical baseline for future evaluation and improvement of AMS program effectiveness.

A pharmacist-led partnership between Malawi and Wales significantly strengthened AMS activities in two tertiary referral hospitals through a collaborative and sustainable approach.

The first Global Point Prevalence Survey (GPPS) conducted in Malawi revealed a high reliance on ceftriaxone, emphasizing the need for improved antibiotic prescribing practices.

A train-the-trainer educational model successfully empowered pharmacists, who subsequently trained 120 multidisciplinary professionals and disseminated a practical AMS toolkit for bedside use.

This model demonstrated measurable progress and is scalable, offering a replicable framework to support Malawi’s National Action Plan on AMR and similar efforts in other resource-limited settings.

Participating in AMS programs helped community pharmacists to implement AMS activities in their practice.

Among 55 pharmacy teams, the majority had implemented at least one component of each AMS outpatient core element commitment and action (94.5%), education and expertise (81.8%), and tracking and reporting (67.3%).

Pharmacy teams scored highest in action (81.8%) and commitment (76.4%), while tracking and reporting remained the weakest area (43.6%), indicating the need for improvement in monitoring practices.

Participation in formal AMS programs significantly increased the likelihood of implementing AMS activities among pharmacists (p = 0.048), highlighting the importance of targeted training.

The findings underscore the pivotal role of community pharmacies in outpatient AMS and the positive influence of structured AMS education on stewardship performance.

Community pharmacists have a good knowledge of antibiotics and a positive perception regarding AMS programs.

Pharmacists had great support for involvement in AMS programs.

Further, they advocated for incorporating AMS programs within the community pharmacy level.

Community pharmacists have expanded their role in patient care and public health issues such as outpatient AMS.

Support for dynamic ways and training to support AMS activities.

Community Pharmacists had a high level of awareness regarding AMS, but the practices were poor.

The strategies for AMS showed good practices.

This was shown to influence their provision of patient care in community pharmacies.

A need exists for the provision of educational intervention activities to promote the rational use of antibiotics in community pharmacies and AMS.

There is a need to design and implement AMS programs in all community pharmacies in Zambia.

Highlights the need for ongoing professional development to enhance AMS practices among community pharmacists.

Most of the community pharmacists possess adequate knowledge of antibiotics and AMR; nonetheless, a significant portion of them exhibit poor antibiotic dispensing practices and AMS.

Most of the community pharmacists supported the dispensing of antimicrobials upon official prescriptions.

Community pharmacists had poor antibiotic dispensing practices.

Significant increases in knowledge were observed after the implementation of the teaching activity.

Knowledge of the correct use of antibiotics for bacterial diseases rather than viral diseases rose from 43% to 76% in the post-test (p < 0.01).

Knowledge of the risk of bacterial resistance to antibiotics from their incorrect use rose from 48% to 74% in the post-test (p < 0.05).

The perceptions of pharmacists regarding AMS programs were positive.

However, gaps in knowledge about some aspects of antibiotics and participation in AMS programs were found.

The development of regional community-based AMS programs is urgently required.

AMS programs are a key strategy of the WHO global action plan to combat AMR, yet evidence from private healthcare settings in Africa remains limited.

Only a few studies exclusively from South Africa reported successful implementation of AMS programs in private healthcare, highlighting a significant research and reporting gap across the continent.

Effective interventions in these settings include locally driven prescription audits and pharmacist-led initiatives, demonstrating practical approaches to AMS.

To strengthen the fight against AMR, private healthcare settings in Africa must adopt evidence-based AMS programs and actively report on antibiotic use and outcomes.

Most community pharmacists were aware of AMS but reported limited training (76.5%) and access to AMS guidelines (93.6%), highlighting the need for targeted education and resource support.

Community pharmacists (CPs) frequently performed clinical checks before dispensing antimicrobials, including counselling (97.0%) and reviewing allergies or drug interactions (93.8%), demonstrating readiness to contribute to AMS.

Collaboration with general practitioners (GPs) was limited, with only 41.8% contacting GPs about suboptimal prescriptions, largely due to perceived GP resistance to pharmacist input.

There was strong support for policy changes to enable AMS, including improved GP-CP collaboration (92.4%), restricted antimicrobial access (74.4%), and reduced repeat dispensing (74.2%).

A pharmacist-led, laboratory-supported AMS intervention significantly reduced antibiotic consumption, treatment duration, and in-hospital mortality, demonstrating the feasibility and impact of such interventions in a low-resource setting.

During the intervention phase, 96% of AMS team recommendations were accepted, with 54% involving discontinuation of unnecessary antibiotics—highlighting strong clinician receptiveness.

Cessation of the audit-feedback intervention led to a 51.6% increase in antimicrobial use, longer hospital stays, and doubled in-hospital mortality, underscoring the need for continuous AMS efforts.

Sustainable AMS impact requires institutional support and leadership commitment, especially in LMICs where resource constraints and syndromic treatment practices are prevalent.

Medical students found the team-based learning (TBL) components of the AMS course, including readiness assurance testing, application activities, and team dynamics, to be effective.

The pre-class webcasts used for preparation were found to be ineffective by the students.

The study provides insights that can inform future implementations of TBL-based AMS education for medical students.

This study offered a first glimpse into the attitudes of pre-clinical medical students toward TBL as a strategy for introducing AMS.

It can serve as a roadmap for educators contemplating the implementation of a similar program at their institution and as a launching pad for research on the effects of this type of intervention on physician prescribing habits.

AMS programs improve rational antibiotic use, reduce AMR, decrease complications of antibiotic use, and improve patient outcomes.

Many health professional students lack confidence and competence in antibiotic prescribing, highlighting the need to integrate AMS teaching into undergraduate curricula.

Proper undergraduate education on rational antibiotic use would enable future health professionals to enter clinical practice as competent, rational prescribers.

Incorporate AMS content into the medical school curriculum.

Evaluate the status and effectiveness of AMS curricula.

Research the long-term outcomes of AMS training.

AMS-related content in the medical school curriculum is recommended.

AMS programs are typically led by infectious disease physicians and pharmacists, to optimize patient outcomes, reducing AMR, decreasing adverse events, and controlling costs.

There is a shortage of formally trained pharmacists to serve as AMS coordinators.

The paper proposes a model to engage pharmacy students and residents/fellows in AMS programs, but further research is needed to assess the impact.

The tool showed positive trends in increasing AMS knowledge among both health and non-health students, highlighting the effectiveness of peer education in this context.

A novel origami fortune teller was designed as an interactive tool to teach university students core antibiotic principles such as proper indications, resistance, and non-pharmacological strategies.

Peer educators facilitated engagement with students at a wellness fair, using real-life case scenarios embedded in the tool to enhance understanding of AMS.

Pre- and post-assessment scores demonstrated a significant increase in student understanding after using the tool (from 69.5% to 96.6%, p ≤ 0.05), indicating its educational effectiveness.

The tool effectively promoted awareness of AMU and AMR in the general university population, highlighting its potential for wider public health education.

69% had previously used antibiotics, mostly from healthcare providers. 51% demonstrated good knowledge of antibiotic use and resistance, but misconceptions about treating viral illnesses and resistance mechanisms were prevalent. Recommended increasing awareness to correct misconceptions.

While 51% of students demonstrated good knowledge of antibiotics and AMR, a significant 76% incorrectly believed that AMR results from the body becoming resistant to antibiotics.

A total of 41% of respondents wrongly believed antibiotics are effective against viral illnesses like colds and flu, highlighting persistent misconceptions.

Only 14% of students had poor overall knowledge, indicating potential for targeted educational interventions to address specific gaps.

These findings underscore the importance of incorporating AMS principles into health education curricula to correct misconceptions and promote rational antibiotic use among future prescribers.

University students are a key AMS target group: As emerging adults developing lifelong health behaviours, undergraduate students represent a strategic population for AMS education to promote responsible antibiotic use.

Potential for long-term impact: AMS initiatives during this transitional life stage can shape positive, sustained antibiotic use practices, influencing not only personal health but also public health outcomes for future generations.

The gap in current research: Despite the clear opportunity, there is limited research evaluating AMS programs or interventions within university health systems.

AMS is vital in youth education: Implementing AMS efforts in college settings can drive early behavioural change, making it a critical avenue for tackling AMR through public health and educational strategies.

Highlighted the need for improved education on antibiotic use and resistance across both human and animal health disciplines to foster better AMS practices.

While 95% of healthcare students acknowledged AMR as a serious future concern, only 69% recognized that their professional use of antibiotics could contribute to the problem.

Only 20% of students felt adequately prepared with knowledge of antibiotic use for their future roles, highlighting a critical gap in AMS-related education.

Despite recognizing the significance of AMR, misconceptions about antibiotic use remain among students across disciplines, including medicine, pharmacy, veterinary, and dentistry.

Targeted AMS training using behavioural insights methods is necessary to address misconceptions and strengthen responsible antibiotic use among the next generation of healthcare professionals.

Completion of the AMS curriculum significantly improved students’ ability to describe the roles of different health professions in antimicrobial use (from 34% to 82%) and enhanced team communication skills (from 75% to 94%).

Students’ ability to describe collaborative approaches to appropriate antimicrobial use rose significantly after the training (from 49% to 92%).

The AMS curriculum, which included online modules and small-group workshops, received high favorability ratings from students—85% for the module and 93% for the workshops.

Introducing AMS education early in medical and pharmacy training significantly improves students’ knowledge, attitudes, and readiness for collaborative antimicrobial decision-making in future practice.

Laboratories play a vital role in AMS programs by:

Speeding up the laboratory workup of samples of particular significance;

Rapid reporting of positive and negative test results: Microbiology red phone;

Rapidly searching for certain pathogens;

Rapid antimicrobial susceptibility testing;

A systematic search for conflictive pathogens;

Rapid detection of resistance.

Alliance with clinical pharmacy and the stewardship committee to influence prescription: checklists.

Statistics for clinicians and epidemiologists: the stewardship committee

Periodic meetings with groups of physicians and nurses.

Rapid diagnostic integration with AMS significantly reduced time to optimal (from 80.9 h to 23.2 h) and effective antibiotic therapy (from 89.7 h to 32 h), enhancing early targeted treatment of resistant infections.

Hospital length of stay and ICU stay were markedly shortened (from 23.3 to 15.3 days and 16 to 10.7 days, respectively), indicating improved patient outcomes and more efficient resource use.

The intervention was associated with a notable reduction in 30-day all-cause mortality (from 21% to 8.9%) and remained an independent predictor of survival.

Cost-effectiveness was evident, with a reduction of $26,298 per inpatient survivor and an estimated $2.4 million in annual hospital savings.

Integration of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and rapid antimicrobial susceptibility testing with AMS significantly reduced hospital length of stay (from 11.9 to 9.3 days; P = .01).

Multivariate analysis showed the AMS intervention (HR 1.38) and timely active therapy at 48 hours (HR 2.9) were independently associated with shorter hospital stays, emphasizing the importance of early targeted treatment.

Mean hospital costs per patient were significantly reduced by over $19,000 ($45,709 to $26,162; P = .009), demonstrating the economic benefit of integrating rapid diagnostics with stewardship.

The findings highlight the clinical and financial advantages of embedding rapid microbial identification within AMS programs, with potential to scale across diverse patient care settings.

Discussed the role of rapid molecular diagnostics in AMS.

Concluded that these diagnostics significantly reduce time to pathogen identification and susceptibility results, leading to more targeted therapy and reduced inappropriate antibiotic use.

AMS programs aim to optimize the appropriate use of existing antimicrobial agents to improve outcomes for patients with MDR gram-negative infections, curb the spread of resistance, and lower hospital costs.

Explored diagnostic stewardship as a strategy to combat AMR. Found that appropriate use of laboratory testing can optimize antibiotic prescribing, reduce unnecessary antibiotic use, and improve patient outcomes.

Diagnostic stewardship ensures the selection and use of appropriate tests tailored to the clinical setting and guides testing toward the right patients.

AMS translates rapid diagnostic results into timely and appropriate clinical actions, ultimately improving patient outcomes.

Reviewed the impact of rapid diagnostic testing in clinical microbiology on AMS.

The study concluded that rapid tests enhance the ability to quickly identify pathogens and resistance markers, thereby supporting timely and appropriate antimicrobial therapy.

Assessed the impact of rapid multiplex PCR (rmPCR) on the management of bloodstream infections.

The study found that rapid testing combined with AMS intervention reduced time to effective therapy and hospital length of stay.

Rapid multiplex PCR (rmPCR) significantly reduced the time to microorganism identification (1.3 vs. 22.3 hours) and enabled quicker antimicrobial adjustments.

Combining rmPCR with AMS led to decreased use of broad-spectrum antibiotics, increased use of narrow-spectrum β-lactams, and reduced treatment of contaminants.

The rmPCR/AS approach resulted in the fastest antimicrobial de-escalation and escalation decisions, demonstrating the added value of stewardship in optimizing therapy.

AMS programs have lagged in animal health compared to human health but their implementation is required to address AMR.

Veterinary AMS is essential to the One Health movement, promoting awareness of AMR among prescribers.

The reviewed educational resources cover key AMS themes, such as AMR mechanisms and rational antimicrobial use, while providing strategies to effectively communicate this knowledge to pet owners and farmers.

The findings also highlight gaps in veterinary curricula that, if addressed, could enhance AMS education.

Key areas for improvement include better integration of clinical rotations with pre-clinical theory, more effective training in antimicrobial best practices, and greater incorporation of international and national antimicrobial use guidelines to strengthen knowledge of drug classes across species and disease.

AMS interventions led to a 50% reduction in antimicrobial prescribing rates over four years, with significant decreases in the use of high-importance antimicrobials.

AMS interventions were implemented across a large network of general veterinary practices.

These interventions led to a reduction in overall antimicrobial use.

There was a notable shift toward using antimicrobials classified as low importance.

The most significant impact was observed in clinics with previously high prescribing rates.

Veterinary technicians are knowledgeable about antimicrobials but often lack a full understanding of AMR and AMS concepts.

They can identify antimicrobial misuse and already contribute through client education and communication with veterinarians.

There is strong interest among technicians to participate in AMS programs.

Barriers include hierarchical practice structures, time constraints, and limited AMS-specific training.

Targeted education and systemic changes are needed to enable meaningful involvement of veterinary technicians in AMS efforts.

Implementation of PROTECT-ME guidelines changed prescribing behaviours, notably reducing cefovecin use in cats and metronidazole use in dogs. However, overall prescription rates increased over time.

Discussions around AMS are more likely to influence the choice of antimicrobial prescribed rather than the decision to prescribe or not.

AMS interventions may be more effective when focused on promoting appropriate antimicrobial selection rather than solely aiming to reduce prescription frequency.

Veterinarians recognize the importance of AMS and understand its principles, but face practical barriers to consistently applying judicious antimicrobial use.

Technological tools are viewed as beneficial for AMS, provided they assist with prescribing decisions and deliver concise, reliable stewardship guidance.

Successful AMS tools must integrate seamlessly into existing clinical workflows, ensuring ease of use without disrupting practice efficiency.

There is a need for centralized access to antimicrobial use data, regional AMR patterns, and communication aids to support AMS in companion animal practice.

Fluoroquinolones were the most frequently prescribed WHO critically important antimicrobials (CIAs) in both dogs and cats, with limited use of highest-priority classes like carbapenems and polymyxins.

Adherence to antimicrobial use guidelines was suboptimal (57.8%), mainly due to lack of culture and susceptibility (C/S) testing and unnecessary use of higher-tier antibiotics.

Although C/S testing increased post-AMS guideline implementation, overall guideline adherence remained low, with no observed change in infection confirmation, culture positivity, or resistance patterns.

These findings indicate the need to strengthen AMS programs in animal health.

The lack of studies describing the animal health sector precluded a meta-analysis.

Employing interventions such as veterinarian guidance on husbandry, biosecurity, or AMU, educational programs, AMU evaluation and feedback, and initiatives to implement infection prevention and control methods resulted in a significant overall reduction in AMU (p < 0.05).

Therefore, there is a need to instigate effective and efficient AMS programs in animal health to reduce and curb AMR.

Programs for AMS have not yet been extensively adopted in veterinary practice.

The cost of microbiological testing, client expectations and practice competition, a lack of AMS governance structures, and limited access to AMS resources, education, and training were the main obstacles.

Concern for how veterinary antibiotic usage contributes to the emergence of AMR in humans, pride in the services rendered, and readiness to modify prescribing procedures were the enablers.

The study provides insights that can inform the development and implementation of AMS programs in veterinary practices by identifying key factors influencing veterinarians’ prescribing behaviour.

AMS programs in livestock have not yet been established, and there is a lack of awareness of AMR.

Measures like the National Health Policy, the National Action Plan on AMR, and the National Program for Containment of AMR demonstrate a commitment to tackling the issue of AMR in the nation.

Incentives to increase their adoption should be investigated, as should involving stakeholders in a “theory of change” exercise through interventions that address AMR from the standpoint of animal health.

Interventions that address AMR from the animal health perspective should be promoted, and incentives to increase their adoption explored.

Coordinated AMS programs that take into account complex problems and local knowledge can lessen the burden of AMR.

Globally, there has been emphasis on the need for health workers to increase their understanding of AMR and AMS. Many healthcare professionals attribute AMR to the acts of others, even if they acknowledge that these are frequently motivated by a lack of options.

Addressing the blame narrative that pervades the AMR discourse, raising awareness of the obstacles to optimal AMS, and lowering the structural factors limiting providers’ daily practices requires the participation of the larger AMR community in discussions of the challenges that have been identified.

Implement structured, context-specific AMR communication campaigns that are co-designed with target audiences and guided by communication and behaviour change theories to enhance public awareness and understanding.

Utilize a logic model framework, such as the SNAP-AMR Logic Model, to plan, implement, and evaluate communication interventions by clearly mapping resources, activities, outputs, and desired outcomes.

Promote the adaptation and use of validated communication models like Supporting the National Action Plan for AMR (SNAP-AMR) in countries with similar socio-cultural and economic contexts to support national AMR action plans and maximize campaign effectiveness.

•To improve the management of the AMR phenomenon, AMS must be used more extensively.

Programs that strengthen governance, raise awareness, establish and improve AMR surveillance, and apply best practices for AMR in agrifood systems are all necessary to improve AMS.

•The idea of AMS in animal health is difficult to understand globally since it may be seen as abstract. In any event, it is crucial to emphasize that antimicrobials are shared resources that we must all protect as doing so will eventually result in a better and more sustainable future.

Widespread implementation of AMS is essential to control AMR, especially in agrifood systems where misuse affects human, animal, plant, and environmental health.

The FAO supports AMS efforts by strengthening governance, raising awareness, enhancing AMR surveillance, and promoting best practices in low- and middle-income countries.

Global initiatives such as the FAO’s InFARM platform, campaigns to reduce antimicrobial use, and promotion of Codex AMR standards are critical for advancing responsible antimicrobial use and achieving sustainable development goals.

AMR surveillance provides critical data to inform and tailor AMS strategies, including empirical treatment choices and policy formulation.

Effective surveillance ensures AMS efforts extend beyond acute care to long-term care, outpatient, and veterinary settings, promoting a One Health approach.

Without robust AMR surveillance, AMS policies may be misdirected, risking increased MDR and adverse clinical outcomes.

Data linkage in AMR surveillance enables a more comprehensive analysis of resistance patterns and dynamics, supporting hypothesis generation and targeted AMS interventions.

Linked AMR surveillance data provide actionable insights that influence clinical practice, guideline development, and future public health policies.

These studies highlight the importance of methodological improvements, better data access, and governance to strengthen AMR surveillance and its impact on AMS programmes.

AMR surveillance provides accurate, real-time data to guide evidence-based decision-making, improve clinical practices, shape national policies, and optimize empirical treatment protocols.

Surveillance systems strengthen laboratory infrastructure through standard operating procedures (SOPs), quality management systems, and harmonized antimicrobial susceptibility testing (AST), leading to better diagnosis and reduced misuse of antibiotics.

Robust surveillance allows AMS programmes to identify resistance trends, detect emerging threats, and evaluate the impact of interventions, thereby enabling targeted stewardship strategies and rational antimicrobial use.

Integrated surveillance systems across human, animal, and environmental health sectors enhance AMR response and pandemic preparedness, especially through regional data sharing and outbreak detection.

Surveillance data inform national health planning by identifying laboratory capacity gaps, guiding resource distribution, and training healthcare professionals in diagnostics, data interpretation, and reporting.

The review identified six key themes affecting AMR surveillance systems: surveillance capacity, data infrastructure, policy, representativeness, stakeholder engagement, and sustainability.

Data infrastructure was the most frequently cited challenge (75%), indicating a critical need for investment in digital tools and reporting systems.

Stakeholder engagement emerged as the most common success factor (65.2%) in the effective implementation and use of surveillance systems.

Surveillance systems in low- and middle-income countries require further development and refinement to become representative, sustainable and aligned with global AMR surveillance objectives.

This study developed a structured methodology for integrating AMU and AMR data across multiple food animal species at the farm level, using the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) framework.

Integration involved six key steps, including descriptive analysis, result synthesis, outcome selection, use of AMU indicators, analytical modelling, and data visualization.

Standardized metrics such as mg/Population Correction Unit (PCU) and AMR adjusted for animal biomass were incorporated to enable cross-species comparisons and inform stewardship strategies.

The integrated approach supports enhanced surveillance and AMU stewardship by providing a more comprehensive understanding of the relationships between AMU and AMR trends within and across species.

Identified IPC as a cost-effective intervention against AMR, highlighting the need for prioritizing IPC research and implementation.

IPC programs are essential to reducing healthcare-associated infections (HAIs), which directly lowers the need for antibiotics and helps prevent the emergence and spread of resistant pathogens—making IPC a foundational pillar in AMR containment and AMS implementation.

Understanding and addressing barriers such as socio-economic factors, behavioural practices, overcrowding, and infrastructure gaps is crucial for effective IPC implementation, which in turn strengthens AMS outcomes and overall infection control.

Highlighted the burden of healthcare-associated infections and the importance of IPC and AMS programs in reducing infection rates and improving patient safety.

A multistate survey found that 4% of hospitalized patients had at least one HAI, with pneumonia and surgical-site infections being the most common.

Clostridium difficile was the leading pathogen, responsible for 12.1% of HAIs, underscoring the need for focused AMS and infection control efforts.

Only 25.6% of HAIs were device-associated, suggesting the need to broaden surveillance and prevention efforts beyond traditional device-related infections.

Public health strategies should expand to include a wider range of HAIs while maintaining efforts to reduce C. difficile and other high-burden infections through AMS and infection prevention programs.

Demonstrated that multimodal IPC strategies, including AMS components, led to significant reductions in healthcare-associated infections.

Al technology constitutes can be used to predict novel antibiotic compounds, while image-based can help identify resistant bacteria.

Al can also predict potential resistance sites and related enzymatic functions, laying the groundwork for designing better antibiotics.

More antibiotics or antimicrobials are expected to make it through the drug development pipeline and enter the market.

AI could help build systematic models to rapidly diagnose diseases and automatically recommend more personalized treatments for patients in clinical practice.

The use of machine learning algorithms to analyze genomic sequences can help to quickly identify specific mutations associated with AMR.

AI-based decision support systems can guide clinicians in choosing the most appropriate antibiotics, reducing inappropriate use and minimizing the risk of AMR development e.g. implementation of a CDSS can help to analyze real-time patient data and microbiological information in order to suggest the most effective therapies while taking into account clinical history and local patterns of resistance.

AI can help to personalize antibiotic regimens by analyzing large amounts of patient data, including genetic information, aiding in the prediction of individual responses to different antibiotics.

A multidisciplinary approach that integrates AI with other emerging technologies, could be effective in the mitigation of AMR, preserving the efficacy of antibiotics for future generations.

The models achieved 80% single-cell accuracy in distinguishing untreated and treated susceptible E. coli cells across four antibiotics. For ciprofloxacin, the models identified significant differences (p < 0.001) between bacterial populations impacted by treatment, with phenotypic effects correlating with clinical susceptibility at 10 mg/L over 30 minutes.

Testing six E. coli strains with varying ciprofloxacin resistance levels revealed that single-cell phenotyping could match the information provided by growth-based antimicrobial susceptibility testing (AST) assays, but within just 30 minutes.

AI has the potential to enhance the detection of AMR genes and aid in identifying antibiotic targets, as well as bactericidal and bacteriostatic molecules suitable for antibiotic development.

AI models are now capable of identifying ARGs from short next-generation sequencing raw reads or fully assembled genes. However, ARGs detected using AI still require validation through experimental, non-computational methods.

This therefore means that AI can be used as a tool and guided by domain experts to help address the problem of AMR.

The study showed that a data-driven POMDP model improved sepsis management by recommending optimal antibiotic administration policies, resulting in favourable outcomes for 49% of cases compared to 37% with alternative approaches (P = 1.3e−13).

Patients under the optimal policy experienced significantly more transitions to better or stable states (605 vs. 344 patients, P = 8.6e−25) and fewer transitions to worse states (33.7% vs. 51.2%, P = 4.6e−117).

Mortality prediction achieved an AUC of 0.7 with up to 82% accuracy, while length-of-stay prediction had AUCs between 0.69 and 0.73 with similar accuracy.

These findings highlight the potential of this probabilistic framework to enhance clinical decision-making in sepsis treatment and pave the way for its application in other medical conditions with sufficient training data.

The study assessed the performance of GPT-4 and a customized EUCAST-GPT agent in detecting beta-lactamase resistance mechanisms in Gram-negative bacteria, using routine diagnostics and microbiologists as references.

GPT models achieved high sensitivity for ESBL (95.4%), AmpC (96.9%), and carbapenemase (100%) detection, but lower specificity for ESBL (69.23%) and AmpC (86.3%), potentially leading to increased testing and costs.

Microbiologists demonstrated higher overall accuracy, with 94.4% concordance across 862 phenotypic categories, and provided concise reasoning compared to GPT agents.

While GPT-4 showed promise, its unspecific flagging and lack of regulatory approval highlight the need for further validation before clinical use.

AI, particularly machine learning models, plays a crucial role in AMS by optimizing empirical antibiotic selection, predicting resistance patterns, and improving treatment appropriateness.

These technologies support timely and precise adjustments to antibiotic regimens, helping reduce mortality and improve patient outcomes.

AI aids in personalized antibiotic dosing, such as for vancomycin, enhancing therapeutic efficacy while minimizing resistance development.

AI models in AMS can significantly enhance decision-making by identifying more cases requiring targeted interventions, such as discontinuation, IV to PO switch, and de-escalation compared to conventional strategies.

These models not only improve the efficiency of AMS programs by prioritizing high-impact cases but also provide explainable insights that align with clinical reasoning.

Therefore, AI supports more precise, data-driven antimicrobial use, contributing to the fight against AMR.

Nanoparticles like silver, zinc oxide, and titanium dioxide exhibit antimicrobial properties through membrane disruption and oxidative stress.

They offer broad-spectrum activity and a lower risk of resistance development.

Silver nanoparticles demonstrated enhanced antibacterial and antibiofilm activity against Gram-positive and Gram-negative bacteria, making them potential alternatives to antibiotics.

Nanotechnology can enhance AMS by improving the targeted delivery and efficacy of antibiotics, thereby reducing unnecessary exposure and minimizing AMR development.

Nanoantibiotics can penetrate biofilms and treat resistant bacterial infections more effectively than conventional antibiotics, supporting better infection control.

Additionally, their synergistic effects with existing antimicrobials offer a strategy to restore the potency of older drugs and limit the emergence of MDR pathogens.

Silver and copper nanoparticles show effective antimicrobial action and can be integrated into surfaces, textiles, and medical devices to reduce microbial load.

Emphasized the potential of nanoparticle-based drug delivery systems to enhance the efficacy of antibiotics and reduce off-target effects.

Developed liposomal and polymeric nanoparticles for targeted antibiotic delivery, which improved drug stability and reduced dosage requirements.

Silver nanoparticles demonstrate potent anti-HIV activity by primarily targeting the early stages of viral replication. They inhibit viral entry by binding to gp120, thereby blocking CD4-dependent fusion and infectivity, and also affect post-entry stages, making them effective against both cell-free and cell-associated HIV strains.

Given their broad-spectrum activity and low risk of inducing resistance, silver nanoparticles hold promise as a novel preventive agent against diverse HIV-1 strains.

Advocated for the integration of green-synthesized nanoparticles in infection control, citing lower toxicity and sustainable production methods.

Silver nanoparticles offer a promising strategy to address AMR and support AMS by exerting broad-spectrum antibacterial effects through mechanisms such as membrane disruption, DNA interaction, and reactive oxygen species generation, although the exact mode of action and potential for resistance development remains under investigation.

Silver and copper nanoparticles show effective antimicrobial action and can be integrated into surfaces, textiles, and medical devices to reduce microbial load.

Emphasized the potential of nanoparticle-based drug delivery systems to enhance the efficacy of antibiotics and reduce off-target effects.