Antimicrobial stewardship from a One Health perspective.

The global rise of antimicrobial resistance (AMR) poses a profound threat to human, animal and environmental health. Although antimicrobials have revolutionized modern medicine, their overuse and misuse have accelerated AMR, necessitating urgent, multisectoral action. Antimicrobial stewardship (AMS), a set of coordinated strategies that promote responsible antimicrobial use, has emerged as a key intervention in managing AMR. In this Review, we explore AMS within a One Health framework, emphasizing interconnectedness across sectors. We examine clinical, economic, sociocultural and environmental drivers of antimicrobial use, highlighting disparities between high-income and low-income settings and identifying context-specific challenges to implementation. We also discuss the importance of governance, financing, digital innovation, surveillance and behavioural science in shaping sustainable AMS programmes, and we consider core components, such as policy integration, surveillance of appropriateness, and context-aware interventions. This Review ultimately advocates for equity-focused strategies that better account for structural barriers, support marginalized populations, and ensure global access to high-quality antimicrobials. By aligning political will, funding and scientific innovation, AMS programmes can be scaled effectively to preserve antimicrobial efficacy, mitigate AMR, improve health outcomes, and promote global health security. The paper concludes with key recommendations for embedding AMS across sectors as a sustainable response to AMR.