ENHANCE: a global collaborative research programme investigating the role of homeopathy in antimicrobial stewardship

Antimicrobial resistance (AMR) is a leading global health threat. Primary care accounts for approximately 80% of human antibiotic use, making novel non-antibiotic strategies for common self-limiting infections an urgent need. Traditional, Complementary and Integrative Medicine (TCIM), including homeopathy, is widely used worldwide; the existing literature on homeopathy suggests a directional signal of potential reductions in antibiotic use in both human and veterinary settings, though the evidence base remains heterogeneous and methodologically limited. The ENHANCE (rEsearch programme oN Homeopathy and Antimicrobial resistaNCE) international collaborative Programme was established in 2023 to systematically evaluate homeopathy's role in antimicrobial stewardship (AMS) through five integrated workstreams: 1) population studies, 2) AMR literature monitoring, 3) Condition-specific systematic reviews, 4) Core outcome set development, and 5) Primary evidence generation. Completed outputs include systematic reviews for otitis media (2024) and tonsillitis (2026), the first internationally agreed Core Outcome Set for acute otitis media (COS-AOM, 2025), and a nationally representative UK survey showing that homeopathic product use occurs in about 5% of the population (an estimated 2.7 million people), with 4% (around 2.2 million people) consulting homeopathic practitioners (2026). Ongoing work includes systematic reviews and core outcome sets for tonsillitis and sinusitis, and the design of pragmatic primary care trials and real-world evidence studies aligned with WHO- and One Health AMR and AMS strategies. ENHANCE provides the methodologically rigorous, internationally coordinated infrastructure needed to determine whether homeopathy can meaningfully contribute to antibiotic-sparing stewardship.