Combating Global Antibiotic Resistance: Emerging One Health Concerns in Lower- and Middle-Income Countries

To address the global antibiotic resistance crisis, a One Health perspective is increasingly needed in lower- and middle-income countries. Here, we describe strategies that consider growing antibiotic use among intensively produced meat and fish, poor food safety, and widespread environmental pollution.Antibiotic misuse in lower- and middle-income countries (LMICs) contributes to the development of antibiotic resistance that can disseminate globally. Strategies specific to LMICs that seek to reduce antibiotic misuse by humans, but simultaneously improve antibiotic access, have been proposed. However, most approaches to date have not considered the growing impact of animal and environmental reservoirs of antibiotic resistance, which threaten to exacerbate the antibiotic resistance crisis in LMICs. In particular, current strategies do not prioritize the impacts of increased antibiotic use for terrestrial food-animal and aquaculture production, inadequate food safety, and widespread environmental pollution. Here, we propose new approaches that address emerging, One Health challenges.