**9. Conclusions**

There is a need for regulations to be established and implemented in many areas related to antimicrobials in the environment. The areas to focus are the pharmaceutical industry, hospitals, wastewater treatment plants, aquaculture farms, poultry farms, pig farms, and households. Other key areas to focus are strengthening and persevering awareness and education, antimicrobial stewardship strategies inclusive of environmental risk sensitization and management, pharmaceutical take-back programs, designing greener antimicrobials with better degradability in the environment, implementing environmental risk assessment prior to the launch of new drugs, monitoring release of antimicrobials into the environment, and eco-pharmacovigilance. The risk of using sewage/wastewater for irrigation needs to be carefully evaluated. Toxicological effects of antimicrobial use on non-target organisms and the environment should be addressed and informed to practitioners. There is a need to use less costly methods for antimicrobial residue measurements. Additionally, there should be methods of monitoring progress of correctives.

The whole gamut of antimicrobial/antibiotic use, antimicrobial/antibiotic residues, antimicrobial/antibiotic resistance, resistance genes, and horizontal gene transfer is interconnected, one leading to another and finally resulting in increased antimicrobial/antibiotic use, which further leads to the same consequences. Therefore, there is a need to develop and implement instruments to carefully monitor antimicrobial/antibiotic use in community, animals, and hospitals, as well as residues, resistant microbes/bacteria and resistance genes in all compartments of the environment, and to update this information on a continuous basis. The crisis of antimicrobial/antibiotic resistance is reaching unmanageable proportions and if immediate measures are not taken to resolve the problem, simple infections may become life threatening.

**Funding:** This research received no external funding.

**Conflicts of Interest:** The authors declare no conflicts of interest.
