A One Health Framework for Antimicrobial Resistance: Connecting Clinical Practices, Agricultural Systems and Community Behaviour

Abstract

Antimicrobial resistance is a major One Health challenge shaped by interconnected clinical, agricultural, environmental, and behavioural drivers. This narrative review examines how antimicrobial use in human healthcare, livestock, poultry, aquaculture, and crop production contributes to the emergence and dissemination of resistant organisms and resistance genes. It also evaluates transmission through food systems, wastewater, soil, surface water, and community settings. Evidence indicates that inappropriate prescribing, empirical broad-spectrum therapy, self-medication, non-prescription access, intensive animal production, inadequate biosecurity, contaminated manure, agricultural runoff, and poor sanitation collectively increase antimicrobial selection pressure. Resistant bacteria may move between humans, animals, food products, and environmental reservoirs through direct contact, occupational exposure, food-chain contamination, wastewater discharge, and horizontal gene transfer. Effective control requires integrated antimicrobial stewardship, rapid diagnostics, infection prevention, vaccination, veterinary oversight, farm biosecurity, food-safety monitoring, wastewater treatment, public education, and regulated antimicrobial access. Harmonized One Health surveillance should connect clinical, veterinary, agricultural, food, and environmental data through standardized laboratory methods and interoperable systems. Current evidence remains limited by heterogeneous study designs, uneven geographic coverage, inconsistent definitions, and weak surveillance in resource-constrained settings. Coordinated governance, sustainable financing, and multisectoral accountability are essential to reduce transmission, preserve antimicrobial effectiveness, and protect human health, animal health, food security, environmental integrity, and sustainable development across diverse social and economic contexts.