Contextualizing a One Health definition of appropriate antimicrobial use

Antimicrobial stewardship initiatives are designed to improve the appropriateness of antimicrobial use and thereby maximize benefits and minimize risks. Currently, there is no shared understanding of appropriate use. Qualitative research with key stakeholders in human and animal health is critical to inform a One Health definition and to support global stewardship efforts.

Four qualitative focus groups were held in 2024 with livestock producers, consumers, healthcare professionals and policymakers to examine factors affecting antimicrobial use and stewardship. A thematic analysis methodology informed by grounded theory was adopted, capturing themes as they emerged directly from the data.

Thematic analysis identified two themes:Structural and economic barriers; in animal health, consumer demand for free-range or antibiotic-free produce conflicted with practical antimicrobial use. This was compounded by differences between large and small livestock enterprises and regulatory constraints around off-label antimicrobial use. In human health, time pressure, limited access to review appointments and conflicting consumer-prescriber expectations influenced antimicrobial decision-making.Information access and education; participants identified gaps in antimicrobial stewardship education for livestock producers, limited public understanding of appropriate use and underused communication channels to support consistent context-specific messaging.

This study highlights how participants understood appropriate antimicrobial use across One Health sectors and the structural, economic, informational and educational factors they perceived as shaping whether it could be achieved in practice. Establishing contextualized, consensus definitions is essential for measuring prescribing quality, benchmarking practice and targeting stewardship interventions. These findings will inform an international Delphi process to develop practical, implementable One Health definitions of appropriate use.