Fernando de Sá Del Fiol
Journal of Microbiology and Infectious Diseases - 2026;16(2):126-136
Antimicrobial resistance (AMR) is one of the most critical global health challenges and is strongly associated with excessive and inappropriate antibiotic use across human, animal, and environmental systems. The interconnected nature of these sectors highlights the importance of integrated approaches to understanding and mitigating the dissemination of resistant microorganisms. The aim of this review was to critically analyze the relationship between antibiotic use and AMR within human, animal, and environmental ecosystems using a One Health framework. This narrative review synthesized evidence from PubMed/MEDLINE, Scopus, and Web of Science studies published between 2000 and 2024. The literature search focused on antimicrobial use in human medicine, livestock production, aquaculture, pharmaceutical industry effluents, and wastewater contamination. Studies were qualitatively analyzed to identify patterns, regional differences, environmental dissemination pathways, and public health implications associated with AMR. Excessive antibiotic use in humans, livestock, and aquaculture significantly contributes to the emergence and spread of AMR. Environmental contamination through pharmaceutical effluents and wastewater treatment systems further promotes resistance gene persistence and dissemination. Considerable regional disparities were identified, particularly between high-income countries with stricter antimicrobial regulations and low- and middle-income countries with limited regulatory and infrastructure. Evidence consistently show a strong association between antibiotic consumption and resistance indices across multiple ecosystems. AMR is a multifactorial and interconnected global problem requiring coordinated interventions across human, animal, and environmental sectors. Integrated surveillance systems, antimicrobial stewardship programs, stricter environmental regulations, and sustainable alternatives to antibiotics are essential for mitigating the spread of resistance. The One Health framework remains fundamental in guiding global strategies aimed at preserving the effectiveness of antimicrobials and protecting public health.
