Exploring antibiotic stewardship interventions within a One Health context: a scoping review

Antibiotic resistance (ABR) presents a global threat to human health, animal health, and the environment. While ABR is a natural phenomenon, the overuse and misuse of antibiotics in human health, animal health, and food production is a major driver of ABR. As interactions between humans, animals, and the environment are central to the emergence and spread of ABR, adopting a One Health approach is essential to effectively address the issue. In this context, a large range of antibiotic stewardship interventions has been developed to optimize the use of antibiotics. However, we lack a comprehensive overview of the landscape of antibiotic stewardship interventions from a One Health perspective. To address this gap, we conducted a scoping review of existing policy interventions. The literature review used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. We systematically searched three major databases to retrieve interventions meeting our inclusion criteria. We purposively sampled some of these interventions to illustrate the diversity of existing interventions. These sampled interventions were then assessed according to 26 variables related to their general characteristics, development and implementation mode, scope, One Health and equity dimensions, and impacts. We conducted a descriptive analysis on the data extracted to summarize the characteristics of the antibiotic stewardship interventions. The 29 selected interventions focus on communication with stakeholders and the general public, access to antibiotics and their usage, and antibiotic disposal. Regarding their One Health aspects, the interventions varied in terms of collaboration across sectors and levels, engagement with the private sector, and equity considerations. Strong livestock industry engagement, efficient legal and institutional frameworks and provision of alternatives to antibiotics acted as facilitators to intervention implementation and success. Interventions demonstrated effects in terms of changes in antibiotic use, antibiotic resistance, awareness, and practices, as well as impacts on animal health and productivity. This study highlights the persistent dominance of human health objectives in the design and implementation of One Health antibiotic stewardship interventions and the continuous need to strengthen evaluation of such interventions to better understand facilitators and barriers to their implementation as well as intervention impacts.