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Antibiotic resistance presents a major public health challenge at local, national and international levels. At a local level, the challenge is to tackle the antibiotic stewardship agenda, within the clinical governance framework, across all professional groups and specialities. This paper presents the response to this challenge in a large multi‐site NHS trust. The approach focuses around a multi‐disciplinary antibiotic steering group, in which a dedicated infectious diseases pharmacist plays a key role. Proposes seven key elements for a successful antibiotic stewardship programme and discuss examples of local action. These elements are: strong leadership; dedicated individuals with responsibility for leading on antibiotic use; integration into pre‐existing trust structures; harnessing existing resources to deliver change; obtaining local data on prescribing patterns and resistance; communication; and education and training. All pillars of clinical governance are supported by the multi‐disciplinary approach described.

Limiting the use of antibiotics in food animals is a cornerstone of contemporary EU policy. Despite that marketing of antibiotics for growth promotion and nutrition has been banned since 2006, the use is still high and varied. This paper aims to investigate the forces behind the different usage patterns in Italy, with one of the EU’s most extensive use of antibiotics in animals, versus Sweden, with the union’s most restricted use, including how these usage patterns are related to EU and national policies.

The industrial network approach/the 4R resources interaction model is adopted to investigate the major forces behind the different antibiotic usage patterns. Furthermore, the study relies on the notion of three main characteristics related to the use of a resource activated in several user settings (Håkansson and Waluszewski, 2008, pp. 20–22). The paper investigates the Swedish and the Italian using settings, with a minimised, respectively, extensive usage of antibiotics. The study is exploratory in nature and based on qualitative data collected through a combination of primary and secondary sources.

The paper underlines the importance of integrating forces for policy to succeed in attempts to reduce the use of a particular resource. It reveals that Sweden’s radically reduced use was based on great awareness, close interactions between animal-based food producers and policy – and that integrating forces were supported by an era of state-protected food production, with promising ability to distribute the cost of change. The Italian characteristics hindering the integration of forces mounting for reduced use were restricted awareness, top-down business and policy interactions – and a great awareness about the difficulties of distributing the cost of change.

The study deals with the analysis of forces affecting the different usage of antibiotics within two EU settings. The investigation, based on the industrial network approach’s notion of connectivity of economic resources, that is, of exchange having a content and substance beyond discrete transactions, reveals how indirect related contextual forces, neglected by policy, have an important influence on the ability to achieve change, in this case of antibiotics usage patterns.

This study aims to study the distribution characteristics of antibiotic resistance in direct-eating food and analysis of Citrobacter freundii genome and pathogenicity. Residual antibiotics and antibiotic resistance genes (ARGs) in the environment severely threaten human health and the ecological environment. The diseases caused by foodborne pathogenic bacteria are increasing daily, and the enhancement of antibiotic resistance of pathogenic bacteria poses many difficulties in the treatment of disease.

In this study, six fresh fruits and vegetable samples were selected for isolation and identification of culturable bacteria and analysis of antibiotic resistance. The whole genome of Citrobacter freundii isolated from cucumber was sequenced and analyzed by Oxford Nanopore sequencing.

The results show that 270 strains of bacteria were identified in 6 samples. From 12 samples of direct food, 2 kinds of probiotics and 10 kinds of opportunistic pathogens were screened. The proportion of Citrobacter freundii screened from cucumber was significantly higher than that from other samples, and it showed resistance to a variety of antibiotics. Whole genome sequencing showed that Citrobacter freundii was composed of a circular chromosome containing signal peptides, transmembrane proteins and transporters that could induce antibiotic efflux, indicating that Citrobacter freundii had strong adaptability to the environment. The detection of genes encoding carbohydrate active enzymes is more beneficial to the growth and reproduction of Citrobacter freundii in crops. A total of 29 kinds of ARGs were detected in Citrobacter freundii, mainly conferring resistance to fluoroquinolones, aminoglycosides, carbapenem, cephalosporins and macrolides. The main mechanisms are the change in antibiotic targets and efflux pumps, the change in cell permeability and the inactivation of antibiotics and the detection of virulence factors and ARGs, further indicating the serious risk to human health.

The detection of genomic islands and prophages increases the risk of horizontal transfer of virulence factors and ARGs, which spreads the drug resistance of bacteria and pathogenic bacteria more widely.

Antibiotics shortages have become an increasingly common problem in Europe because of several reasons, including the offshoring of the production of active pharmaceutical ingredients for many of these products to low production cost countries, such as China and India. The problem has deteriorated because of the Covid-19 crisis that has put most global value chains (GVCs) under great stress. This situation has boosted extensive discussions among academics, practitioners and policymakers on possible changes to the configuration of GVCs. This paper aims to focus specifically on antibiotics supply chains from the perspective of a small country (Sweden), and analyse the pros and cons of backshoring and nearshoring alternatives, as a means to reduce drug shortages.

This work adopts a systemic perspective to capture the implications of reshoring for the different stakeholders involved in the antibiotics field. The present meso-analysis, focusing at the industry level, is based on multiple sources of primary data collected between 2014 and 2021, including participation in policy-related projects and interviews with over 100 representatives of key stakeholders in the antibiotics field.

This paper shows how reshoring can address the problems of drug shortages and reduce availability risk in antibiotics’ GVCs. However, the authors show that no simple and best solution exists because both alternatives of reshoring, i.e. backshoring and nearshoring, entail pros and cons for different stakeholders. The authors conclude with implications for policymakers and managers.

The analysis of pros and cons of both backshoring and nearshoring for various stakeholders offers relevant implications for research on operations and supply management, international business and economics/political science.

This paper looks at reshoring as a policy-driven decision and provides an innovative systemic perspective to analyse the implications for different stakeholders of two reshoring options concerning the antibiotics supply chain.

Antibiotic resistance (AR) is a global health crisis that is attracting focussed attention from healthcare, public health, governmental agencies, the public, and food producers. The purpose of this paper is to describe the work in Washington State to combat resistance and promote antimicrobial stewardship from a one health perspective.

In 2014, the Washington State Department of Health convened a One Health Steering Committee and two workgroups to focus on AR, the One Health Antimicrobial Stewardship work group and the One Health Antimicrobial Resistance Surveillance work group. The group organized educational sessions to establish a basic understanding of epidemiological factors that contribute to resistance, including antibiotic use, transmission of resistant bacteria, and environmental contamination with resistant bacteria and antibiotic residues.

The authors describe the varied uses of antibiotics; efforts to promote stewardship in human, and animal health, including examples from the USA and Europe; economic factors that promote use of antibiotics in animal agriculture; and efforts, products and next steps of the workgroups.

In Washington, human, animal and environmental health experts are working collaboratively to address resistance from a one health perspective. The authors are establishing a multi-species resistance database that will allow tracking resistance trends in the region. Gaps include measurement of antibiotic use in humans and animals; integrated resistance surveillance information; and funding for AR and animal health research.

This study is oriented towards getting insight into the perspectives, knowledge and practices among Syrian refugees regarding antibiotic use and prescribing in Dutch primary care.

A thematic qualitative study was carried out using semi-structured interviews with 12 Syrian refugees living in the Netherlands. Data analysis consisted of three steps and was oriented towards the development of themes.

Participants were confronted with restricted access to antibiotics in the Netherlands which was contrary to their experiences in Syria. Some of them continued to self-prescribe antibiotics, while others adhered to the Dutch General Practitioner (GP)’s advice. Especially mothers with young children took up the Dutch GP’s advice. Syrian refugees expressed health beliefs about the healing effects of antibiotics which are related to their past experiences of use and which influenced their current use. Respondents complained about the Dutch health-care system and expressed a preference for the one in Syria.

Syrian refugees vary in their way of dealing with restricted access to antibiotics in Dutch primary care. More in-depth knowledge is required to improve refugee patient–doctor communication about antibiotic use.

The message that antibiotics are not needed may be challenging. Additional communication seems to be necessary to persuade Syrian refugees from self-prescribing antibiotics. Therefore, identifying refugee patient concerns and carefully counseling and communicating it with them is substantial. Developing educational toolkits consisting of various experiences of antibiotic use and ways of dealing with it can equip doctors to more adequately react to migrants’ needs for care.

Primary care professionals seem insufficiently equipped to tackle issues related to antibiotic use amongst newly arrived migrants. Therefore, it is important to support professionals in their communication with this patient group about the proper use of antibiotics.

This study shows that more in-depth knowledge is needed about the strategies of newly arrived migrants and their complex reactions to treatment prescriptions with which they are not familiar.

Timely administration of antimicrobials in patients with community‐acquired pneumonia is now a standard of care. The purpose of this paper is to present a large observational study to understand the issues that result in a delay in the administration of antibiotics to patients with community‐acquired pneumonia

This prospective study involved all six hospitals in the Edmonton area: patients were enrolled at the time of hospitalization if they were adults aged ≥17 years with a clinical presentation consistent with community‐acquired pneumonia. A retrospective chart review was performed to determine the reasons why it took more than eight hours to administer the first dose of antibiotics.

The paper finds that of all 3,394 hospitalized patients, 646 (19.0 percent) received antibiotics over four hours after admission to the emergency department and in most instances the delay was more than 12 hours. A total of 30 percent of the delays were justifiable – 17 percent due to diagnostic indecision and 13 percent due to recent receipt of an antibiotic at home or at another institution prior to transfer. All the other delays were unnecessary and easily correctable. In this paper the data indicate that only 5.6 percent of 3,394 patients had an adequate reason for delay in antibiotic administration. Thus a reasonable target for timely administration of antibiotics is at least 90 percent of the patient population.

The strengths of this study lie in its large number of patients, inclusiveness and real world context.

Drawing insights from the culture-centered approach (Dutta-Bergman, 2004; Dutta, 2007), the purpose of this paper is to explore the meanings of, experiences with, and information sources for antibiotics among at-risk yet understudied populations in urban and economic margins in the Global South.

Given the exploratory purpose of this paper, it used qualitative approach specifically focus group discussions with mothers, guardians and female senior citizens from Manila, Philippines.

Antibiotics had multiple meanings – from purposes and modes of acquisition to side-effects. Experiences with antibiotics were not only tied to financial difficulties, but also in administering antibiotics to children or wards and managing side-effects. Furthermore, medical doctors were the most accessed and preferred sources of antibiotics-related information.

To date, this paper is one of the few to argue that knowing the conditions into which antibiotics are situated in the Global South is critical for strengthening global public health campaigns and policies against antimicrobial resistance a and reducing global health inequity.

The aim of this study is to measure the effectiveness of the “Bug Investigators” pack in improving children's knowledge about micro‐organisms, hygiene and antibiotics when it is used within the National Curriculum in junior schools.

Teaching, using the “Bug Investigators” pack, was given by Gloucestershire primary school teachers. Children's general knowledge about hygiene, micro‐organisms and antibiotics was measured by questionnaire before and after lessons using the pack. A sample of 198 children aged 10 and 11 years in eight primary schools completed the questionnaires before and after teaching. A focus group was held with teachers to explore their views after using the pack.

Children's knowledge improved in all topic areas. Improved knowledge was most significant for what antibiotics do and how to use them and the value of our own good bugs (27, 31 and 16 percent improvement respectively). Knowledge about how bugs spread and hand hygiene was excellent (88 and 90 percent) before the education, but there was still 4 percent improvement in these topics. An exploratory discussion with teachers disclosed that some worksheets on viruses and resistant bacteria were too advanced for junior schools.

The study in this paper was undertaken in schools with relatively high‐level four‐science attainment, which could affect generalisability of findings.

The “Bug Investigators” teaching pack was effective at improving knowledge about micro‐organisms, hygiene and antibiotic use; it should be used more widely by junior schools. It is now a recognised teaching resource. Increased awareness of hygiene and prudent use of antibiotics should lower school absenteeism and improve antibiotic use in this generation of future adults.

The recent Standing Medical Advisory Committee’s report The Path of Least Resistance advised a National Advice to the Public campaign aimed at minimising the development of antimicrobial resistance. Describes two 90 minute interactive workshops entitled “Antibiotics and your good bugs” for Year 5 children (nine‐to‐ten years old). Before the workshops, 45 per cent of the children correctly answered all the questions describing antibiotics but, after the workshops, 73 per cent answered correctly. Before the workshops only 23 per cent, 43 per cent, 28 per cent and 26 per cent of the children respectively knew that antibiotics do not kill viruses, do not help colds, do not help hay fever, but do kill our good bacteria, compared with 47 per cent, 76 per cent, 77 per cent and 69 per cent afterwards. These workshops greatly improved the children’s knowledge and understanding of antibiotics and our normal flora. They will prove useful for parties involved in planning the National Advice to the Public campaign on antibiotic resistance in schools.