Antibiotic surveillance: an action-oriented integrated approach

Background: 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 the principles and case study illustrations for establishing antibiotic surveillance in resource-constrained settings. Methods: A technical working group drew together expertise and experience from around the world and across One Health domains to establish the value of antibiotic surveillance across sectors, review tools and guidelines, share experiences and generate principles for prioritisation of surveillance activity. This included a literature review, in person workshop, online meetings and collaborative writing between August 2024 and May 2025. Results: The working group identified multiple purposes for establishing a coordinated antibiotic surveillance within countries, to inform efforts to mitigate antimicrobial resistance (AMR) mitigation efforts and beyond. Tools showed increasing complexity towards the end user level, corresponding with decreasing standardisation in approach. Proposed steps for establishing national antibiotic surveillance included starting where the greatest impact can be anticipated in a given context and alignment with other programmes. Conclusions: 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 surveillance of 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.' Achieving effective antibiotic surveillance requires a collaborative and coordinated strategy focusing on data for action.