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Antibiotics
Special Issues
Global Strategies for Antimicrobial Surveillance: Country, Regional and Global Perspectives
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Global Strategies for Antimicrobial Surveillance: Country, Regional and Global Perspectives

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

Deadline for manuscript submissions: 31 July 2026 | Viewed by 9953

Special Issue Editors

Dr. Gustavo Horacio Marin

E-Mail Website
Guest Editor
CUFAR- Pharmacology Research Center, CONICET—FCMLP- PAHO_WHO, Universidad Nacional de La Plata, 60 & 120, La Plata 1900, Argentina
Interests: antimicrobials; resistance; stewardship; consumption
Dr. Gabriel Levy-Hara

E-Mail Website
Guest Editor
National University of Buenos Aires–Hospital Durand, CABA, Buenos Aires, Argentina
Interests: stewardship; antibiotics; resistance

Special Issue Information

Dear Colleagues, 

Antimicrobial resistance (AMR) is closely linked to the levels of antimicrobial consumption/use (AMU) in each health institution or in geographical areas, and to the measures taken by local authorities to mitigate these resistance problems. In order to understand the results obtained through actions towards achieving AMR-AMU control, including antimicrobial stewardship performed in different countries, and to consider how access and shortages might affect AMU surveillance conducted by the WHO, we call for scientific contributions to this Special Issue.

This Special Issue seeks to gather valuable insights and experiences from around the world. We invite health professionals, researchers, and policymakers to contribute their perspectives through the submission of reviews, research papers, and communications.

We welcome contributions that explore the following themes:

  1. Innovative Antimicrobial Stewardship Programs: Highlighting successful AMS initiatives in diverse healthcare environments.
  2. Surveillance Insights: Presenting data-driven analyses on AMU and AMR trends as reported by countries as well as regional or global organizations.
  3. Policy Development: Offering recommendations for the formulation and implementation of effective AMS policies based on best practices and surveillance findings.
  4. Global Collaborations: Sharing experiences that illustrate how international partnerships can enhance AMS efforts and address the challenges of AMR.

We look forward to receiving your submissions and to advancing the conversation on antimicrobial stewardship and resistance on a global scale.

Dr. Gustavo Horacio Marin
Dr. Gabriel Levy-Hara
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.

Keywords

  • antimicrobial
  • stewardship
  • resistance
  • consumption
  • use

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Published Papers (6 papers)

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Research

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21 pages, 811 KB  
Article
Policy Framework and Barriers in Antimicrobial Consumption Monitoring at the National Level: A Qualitative Study from Pakistan
by Beenish Ihsan, Shahid Muhammad Iqbal, Mohammed Aufy and QurratulAin Jamil
Antibiotics 2026, 15(1), 89; https://doi.org/10.3390/antibiotics15010089 - 15 Jan 2026
Viewed by 718
Abstract
Objectives: The study aims to assess the strategies used to estimate antimicrobial consumption (AMC) and the barriers encountered in data collection. It also addresses the perception about AMC based on the World Health Organization (WHO) definition. Methodology: The qualitative study adhered to the [...] Read more.
Objectives: The study aims to assess the strategies used to estimate antimicrobial consumption (AMC) and the barriers encountered in data collection. It also addresses the perception about AMC based on the World Health Organization (WHO) definition. Methodology: The qualitative study adhered to the standard consolidated criteria for reporting qualitative studies (COREQ) guidelines. It involved stakeholders from diverse sectors, i.e., regulatory bodies, the pharmaceutical industry, international health organizations, policy experts, medical professionals, veterinary doctors, and academia (nursing, medicine, and pharmacy). A total of 37 in-depth interviews were conducted using a semi-structured interview schema. The interviews were recorded and transcribed verbatim. Codes were generated afterward and organized into themes. Results: Data analysis yielded five themes consisting of (i) Perception about Antimicrobial Consumption, AWaRe (Access, Watch, Reserve) classification and related terms, (ii) Antimicrobial Consumption: Policy Design, (iii) Data management and record keeping for the Estimation of Antimicrobial Consumption, (iv) Levels of Estimation for Antimicrobial consumption and Organizations, and (v) Challenges and suggested solutions in estimation of AMC: One health approach is the way forward. Conclusions: The study concluded that AMC and AMR are two sides of the same coin. The solution to AMR and excessive AMC is to re-evaluate the policy and implement legislation strictly. Efforts focused on irrational prescribing and unsupervised OTC sales of antimicrobials. This will help in reducing the consumption of broad-spectrum antimicrobials. Full article
(This article belongs to the Special Issue Global Strategies for Antimicrobial Surveillance: Country, Regional and Global Perspectives)
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20 pages, 538 KB  
Article
Bridging the Capacity Building Gap for Antimicrobial Stewardship Implementation: Evidence from Virtual Communities of Practice in Kenya, Ghana, and Malawi
by Ana C. Barbosa de Lima, Kwame Ohene Buabeng, Mavis Sakyi, Hope Michael Chadwala, Nicole Devereaux, Collins Mitambo, Christine Mugo-Sitati, Jennifer Njuhigu, Gunturu Revathi, Emmanuel Tanui, Jutta Lehmer, Jorge Mera and Amy V. Groom
Antibiotics 2025, 14(8), 794; https://doi.org/10.3390/antibiotics14080794 - 4 Aug 2025
Cited by 1 | Viewed by 3985
Abstract
Background/Objectives: Strengthening antimicrobial stewardship (AMS) programs is an invaluable intervention in the ongoing efforts to contain the threat of antimicrobial resistance (AMR), particularly in low-resource settings. This study evaluates the impact of the Telementoring, Education, and Advocacy Collaboration initiative for Health through Antimicrobial [...] Read more.
Background/Objectives: Strengthening antimicrobial stewardship (AMS) programs is an invaluable intervention in the ongoing efforts to contain the threat of antimicrobial resistance (AMR), particularly in low-resource settings. This study evaluates the impact of the Telementoring, Education, and Advocacy Collaboration initiative for Health through Antimicrobial Stewardship (TEACH AMS), which uses the virtual Extension for Community Healthcare Outcomes (ECHO) learning model to enhance AMS capacity in Kenya, Ghana, and Malawi. Methods: A mixed-methods approach was used, which included attendance data collection, facility-level assessments, post-session and follow-up surveys, as well as focus group discussions. Results: Between September 2023 and February 2025, 77 virtual learning sessions were conducted, engaging 2445 unique participants from hospital-based AMS committees and health professionals across the three countries. Participants reported significant knowledge gain, and data showed facility improvements in two core AMS areas, including the implementation of multidisciplinary ward-based interventions/communications and enhanced monitoring of antibiotic resistance patterns. Along those lines, participants reported that the program assisted them in improving prescribing and culture-based treatments, and also evidence-informed antibiotic selection. The evidence of implementing ward-based interventions was further stressed in focus group discussions, as well as other strengthened practices like point-prevalence surveys, and development or revision of stewardship policies. Substantial improvements in microbiology services were also shared by participants, particularly in Malawi. Other practices mentioned were strengthened multidisciplinary communication, infection prevention efforts, and education of patients and the community. Conclusions: Our findings suggest that a virtual case-based learning educational intervention, providing structured and tailored AMS capacity building, can drive behavior change and strengthen healthcare systems in low resource settings. Future efforts should aim to scale up the engagements and sustain improvements to further strengthen AMS capacity. Full article
(This article belongs to the Special Issue Global Strategies for Antimicrobial Surveillance: Country, Regional and Global Perspectives)
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Review

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13 pages, 1026 KB  
Review
Pharmacist-Led Diagnostics: A New Frontier in Antimicrobial Stewardship
by Greta Kaspute and Tatjana Ivaskiene
Antibiotics 2025, 14(12), 1286; https://doi.org/10.3390/antibiotics14121286 - 18 Dec 2025
Viewed by 1164
Abstract
Background: Antimicrobial resistance (AMR) is accelerating globally, driven by widespread inappropriate antibiotic use and diagnostic uncertainty in primary care. Pharmcist-led point-of-care testing (POCTs) has emerged as a promising model to optimize antibiotic prescribing, improve triage, and strengthen antimicrobial stewardship (AMS). Methods: This scoping [...] Read more.
Background: Antimicrobial resistance (AMR) is accelerating globally, driven by widespread inappropriate antibiotic use and diagnostic uncertainty in primary care. Pharmcist-led point-of-care testing (POCTs) has emerged as a promising model to optimize antibiotic prescribing, improve triage, and strengthen antimicrobial stewardship (AMS). Methods: This scoping review synthesizes current evidence, regulatory models, and implementation data on pharmacist-led diagnostics and antibiotic management across multiple countries. Results: Despite strong policy interest, clinical trial evidence remains limited. Existing studies—primarily pilots, feasibility work, and service evaluations—suggest that POCTs combined with structured pathways reduces inappropriate antibiotic use. Conclusions: Regulatory fragmentation, workforce limitations, and insufficient monitoring systems constrain widespread implementation. Larger, well-designed trials are needed to establish long-term safety, clinical outcomes, and AMS impact. Full article
(This article belongs to the Special Issue Global Strategies for Antimicrobial Surveillance: Country, Regional and Global Perspectives)
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23 pages, 646 KB  
Review
Overview of Methods for Assessing Antimicrobial Use in Outpatient Settings in High-Income Countries: A Narrative Review
by Anita Kotwani, Mihir Chauhan, Elizabeth Roughead, Arno Muller, Martina Escher, Benedikt Huttner and Verica Ivanovska
Antibiotics 2025, 14(11), 1161; https://doi.org/10.3390/antibiotics14111161 - 16 Nov 2025
Viewed by 1570
Abstract
Background/Objectives: Over 80–90% of antibiotics are used in outpatient settings, where interactions among diverse prescribers, dispensers, and patients create complex usage patterns. The study examines how outpatient antimicrobial use is monitored in high-income countries (HICs), focusing on data sources and their relevance [...] Read more.
Background/Objectives: Over 80–90% of antibiotics are used in outpatient settings, where interactions among diverse prescribers, dispensers, and patients create complex usage patterns. The study examines how outpatient antimicrobial use is monitored in high-income countries (HICs), focusing on data sources and their relevance for stewardship and surveillance. Methods: This narrative review searched MEDLINE and Embase for English-language studies reporting outpatient antimicrobial use in HICs (from inception to 2023), supplemented by reference screening, targeted Google web searches, and expert input. Studies were categorized by data collection method, study period, and WHO Region. Key characteristics such as patient group, disease focus, country, dataset, and reported outcome measures were also extracted and tabulated. Results: We identified 287 studies, of which 79 met inclusion criteria. Most (n = 76) were conducted after 2000 and spanned all four WHO regions with HICs. Of the 73 studies using surveillance databases, six types were identified: dispensing (n = 13), health insurance (n = 24), GP prescribing (n = 17), commercial (n = 9), procurement (n = 3), and multinational networks (n = 7). Six studies used surveys: general point prevalence (n = 1), indication-specific audits (n = 3), patient exit interviews (n = 1), and community surveys (n = 1). Common outcome measures included DID, Days of Therapy, and patterns of antimicrobial use by season, age, sex, indication, and prescriber. Of the 48 studies published after 2018, nine reported using AWaRe metrics. Conclusions: Surveillance databases were the main method for tracking outpatient antimicrobial use in HICs; surveys were less common. Antibiotic use has increasingly been reported by AWaRe category, especially in prescribing and insurance studies. Further indicators and tech-driven tools are needed to support stewardship. Full article
(This article belongs to the Special Issue Global Strategies for Antimicrobial Surveillance: Country, Regional and Global Perspectives)
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24 pages, 649 KB  
Review
Inventory of Survey Instruments for Monitoring Antimicrobial Use in Primary Care Settings in Low- and Middle-Income Countries: A Narrative Review
by Verica Ivanovska, Tracey-Lea Laba, Renly Lim, Anita Kotwani, Arno Muller, Martina Escher, Benedikt Huttner and Elizabeth Roughead
Antibiotics 2025, 14(11), 1159; https://doi.org/10.3390/antibiotics14111159 - 15 Nov 2025
Viewed by 1105
Abstract
Background: Over 80–90% of antimicrobial use occurs in primary health care, underscoring the need for specific data from this sector to inform practices and interventions to improve antimicrobial use. This study aimed to identify a wide range of research instruments in primary health [...] Read more.
Background: Over 80–90% of antimicrobial use occurs in primary health care, underscoring the need for specific data from this sector to inform practices and interventions to improve antimicrobial use. This study aimed to identify a wide range of research instruments in primary health care and qualitatively describe their structure, scope, and content. Methods: For the narrative review, we reviewed Medline (inception–November 2023) and agency/network websites to identify surveys on antimicrobial use prevalence in LMIC primary care. We applied no language restrictions and extracted survey instruments from publications or requested them from authors when unavailable. Results: We identified 450 studies and extracted 42 survey instruments issued between 1993 and 2023, all but one post-2000. These covered both multi-country (16.7%) and country-specific implementations across all WHO regions. Sampling units included households/consumers (24/42, 57.2%), health professionals (14/42, 33.3%), drug sellers (3/42, 7.1%), and bulk sales data (1/42, 2.4%). Surveys typically captured antimicrobial type, prescription status, and reason for use; AWaRe classification was mentioned only once. We found 13 stand-alone protocols on antimicrobial use and 4 on general medicine use. Conclusions: We identified diverse tools for measuring antimicrobial use in LMICs, though many lacked protocols or analytic support. Surveys often focused solely on antibiotics, used paper-based methods, and rarely referenced the AWaRe classification. Future efforts should broaden the scope beyond antibiotics, leverage digital data systems, include implementation protocols and analytic tools, report standardized indicators, and adopt AWaRe-related variables as a core criterion to strengthen AMU monitoring in PHC. Full article
(This article belongs to the Special Issue Global Strategies for Antimicrobial Surveillance: Country, Regional and Global Perspectives)
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Other

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10 pages, 675 KB  
Technical Note
OrgTRx: A Platform Developed in Queensland for the Extraction and Visualisation of Antimicrobial Susceptibility Data for the Surveillance of Resistance in Microorganisms
by Sonali Coulter, Holly Hamilton, Philadelphia Holmes, Louise Davis, Claire Heney and David Siebert
Antibiotics 2026, 15(1), 63; https://doi.org/10.3390/antibiotics15010063 - 6 Jan 2026
Viewed by 564
Abstract
The OrgTRx platform is a system designed in Queensland, Australia, for the capture of Antimicrobial Resistance (AMR) surveillance data. The data is captured directly from Microbiology Laboratory Information Systems. The most common use of this data is to create facility-specific antibiograms for hospitals [...] Read more.
The OrgTRx platform is a system designed in Queensland, Australia, for the capture of Antimicrobial Resistance (AMR) surveillance data. The data is captured directly from Microbiology Laboratory Information Systems. The most common use of this data is to create facility-specific antibiograms for hospitals and other healthcare facilities. We report on the methods adopted to extract susceptibility results from participating pathology services for AMR surveillance across Australia. OrgTRx receives standardised extracts of antimicrobial susceptibility data from laboratory information systems. This data is validated, verified and incorporated into a database each month. For visualisation by clinical users, the data is displayed in a data cube. The data that is received in this standardised format can be used to review trends in resistance by organism and geographical location of patients presenting with a wide range of infections across Australia. This information can be used to identify areas that require additional resources to combat AMR. The OrgTRx data cube provides clinicians with the tools to create facility-specific antibiograms as well as monitor trends in resistance in pathogens of interest. Increased laboratory capacity and capability, along with adequate funding of surveillance systems, will provide high-quality information to inform the implementation of strategies to prevent the spread of AMR. Full article
(This article belongs to the Special Issue Global Strategies for Antimicrobial Surveillance: Country, Regional and Global Perspectives)
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