From burden to action: Saudi Arabia's strategy on antimicrobial resistance

Antimicrobial Resistance (AMR) is a significant public health challenge in Saudi Arabia and globally. This review consolidates evidence on the burden, drivers, policy responses, and progress in controlling AMR from 2010 to 2025 across human health, animal health, and the environment. The burden is substantial, especially from multidrug-resistant strains such as ESBL-producing Enterobacteriaceae, carbapenem-resistant Klebsiella pneumoniae, and methicillin-resistant Staphylococcus aureus. Factors contributing to this include antibiotic misuse, over-the-counter availability, mass gatherings, insufficient infection control, and agricultural use. Saudi Arabia has made progress through a One Health-oriented National Action Plan (2017, renewed 2022-2025), antimicrobial stewardship programs, surveillance efforts, and stricter regulations. However, challenges remain in community surveillance, laboratory capacity, and behavioral change. As indicated by key stakeholders, further efforts to expand stewardship, improve diagnostics, regulate antibiotic sales, and implement AI-driven surveillance are essential next steps. Increased investment in research, innovation, and partnerships can position Saudi Arabia as a leader in regional AMR containment initiatives.