Strengthening systems to monitor antibiotics. An action oriented approach

Antibiotics have become lynchpins of our modern systems of healthcare, animal health and agriculture. Monitoring the types and volumes of antibiotics distributed, used and discharged across these systems is critical to provide evidence for action. With limited resources, implementation of multiple tools and recommendations for antibiotic monitoring is challenging. This paper sets out principles and case study illustrations for establishing systems to monitor antibiotic supply and use in resource-constrained settings.

A technical working group and wider reference group drew together expertise and experience from 71 individuals representing different countries, continents and One Health domains, to establish the value of monitoring antibiotics, review tools and guidelines, share experiences and generate principles for prioritising action. This included a literature review, in person workshop, online meetings and collaborative writing between August 2024 and May 2025.

The literature search identified two types of outputs: a) antibiotic monitoring and surveillance tools (covering data collection-oriented and residue control tools), and b) guidelines, standards, and mapping/assessment tools for monitoring antibiotics. The group identified multiple purposes for establishing a coordinated system for monitoring antibiotic use across human, animal, plant and environmental domains at country level, including ensuring access, and informing efforts to mitigate antimicrobial resistance (AMR). Tools to monitor use closer to end-user level were less standardised and often more complex. Proposed steps for establishing national antibiotic monitoring systems include starting where the greatest impact can be anticipated in a given context and alignment with other programmes.

The agricultural, population, epidemiological, cultural and economic contexts of different countries mean different starting points for establishing antibiotic monitoring. This project characterised an action-oriented prioritisation approach, targeting collection and collation of antibiotic data that have the highest likelihood of affecting change that can achieve impact. Such an approach is risk-based, prioritising monitoring of the antibiotic use that poses greatest risks as locally defined and is feasible to change; sustainable, aligning local expertise, infrastructure and technology with other country priorities; and transparent, ensuring evidence availability within the system alongside reporting 'up and out.' Effective national antibiotic monitoring systems require a collaborative and coordinated strategy focusing on data for action.