Antimicrobial use and resistance.

Abstract

Antimicrobial resistance affects the delivery of safe and effective healthcare. Antimicrobial resistance has attracted strong political focus, with the 2024 United Nations General Assembly high level meeting providing a clear commitment to reducing mortality and improving antibiotic use. This review summarises recent political action, policy prioritisation, and identification of future threats. It considers infections that are caused by drug resistant pathogens and reviews available and new antibiotics that may meet unmet medical needs. Despite increasing political engagement, the global antimicrobial resistance landscape remains imbalanced. In high income hospital settings, diagnostics, antimicrobial stewardship, and infection prevention and control are improving and may be further enabled by artificial intelligence and information systems. The development and use of new antibiotics is a major focus. By contrast, in low and middle income countries, access to most of these advances is limited. In all settings, empirical prescribing of essential antibiotics remains the cornerstone of treatment and conserving their efficacy is critical to effective healthcare. Targeted prevention and optimal treatment strategies are needed to mitigate antimicrobial resistance across all settings.