Exploring antibiotic stewardship interventions within a One Health context: A scoping review

Léo Delpy^1,2,3Chloe Clifford Astbury^4,5Olivier Kambere Kavulikirwa^6,7Mouhamadou Moustapha SOW^8,9Sandrina Vandenput¹⁰Cécile Aenishaenslin^11,12,13Arne Ruckert⁵Ria Benko^14,15,16Mary Wiktorowicz¹⁷Tarra L. Penney^17,18A.M. Viens^4,5Marion Bordier^1,19,2*

• ¹ASTRE, University of Montpellier, CIRAD, INRAE, Montpellier, France
• ²National Laboratory for Livestock and Veterinary Research, Senegalese Institute of Research in Agriculture, Dakar, Senegal
• ³Center for Sociological and Economics Studies and Research (CLERSE), CNRS, University of Lille, Villeneuve-d'Ascq, France
• ⁴School of Global Health, York University, Toronto, Canada
• ⁵Global Strategy Lab, Toronto, Canada
• ⁶Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada
• ⁷Faculty of Veterinary Medicine, Catholic University of Graben, Butembo, Republic of Congo
• ⁸Department of Public Health and Social Medicine, Faculty of Health Sciences, Gaston Berger University, Saint Louis, Senegal
• ⁹Health Science Application and Research Laboratory, Gaston Berger University, Saint Louis, Senegal
• ¹⁰Health Sciences Library, University of Liege, Liege, Belgium
• ¹¹Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Canada
• ¹²Groupe de recherche en épidémiologie des zoonoses et santé publique, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Canada
• ¹³Centre de recherche en santé publique de l’Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Université de Montréal, Montréal, Canada
• ¹⁴Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
• ¹⁵Institute of Clinical Pharmacy, Albert Szent-Györgyi Health Centre, University of Szeged, Szeged, Hungary
• ¹⁶Emergency Care Department, Albert Szent-Györgyi Health Centre, University of Szeged, Szeged, Hungary
• ¹⁷Dahdaleh Institute for Global Health Research, York University, Toronto, Canada
• ¹⁸Global Food System & Policy Research, School of Global Health, York University, Toronto, Canada
• ¹⁹CIRAD, ASTRE, Dakar, Senegal

Antibiotic resistance (ABR) presents a global threat to human health, animal health, and the environment. While ABR is a natural phenomenon, the overuse and misuse of antibiotics in human health, animal health, and food production is a major driver of ABR. As interactions between humans, animals, and the environment are central to the emergence and spread of ABR, adopting a One Health approach is essential to effectively address the issue. In this context, a large range of antibiotic stewardship interventions has been developed to optimize the use of antibiotics. However, we lack a comprehensive overview of the landscape of antibiotic stewardship interventions from a One Health perspective. To address this gap, we conducted a scoping review of existing policy interventions. The literature review used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. We systematically searched three major databases to retrieve interventions meeting our inclusion criteria. We purposively sampled some of these interventions to illustrate the diversity of existing interventions. These sampled interventions were then assessed according to 26 variables related to their general characteristics, development and implementation mode, scope, One Health and equity dimensions, and impacts. We conducted a descriptive analysis on the data extracted to summarize the characteristics of the antibiotic stewardship interventions. The 29 selected interventions focus on communication with stakeholders and the general public, access to antibiotics and their usage, and antibiotic disposal. Regarding their One Health aspects, the interventions varied in terms of collaboration across sectors and levels, engagement with the private sector, and equity considerations. Strong livestock industry engagement, efficient legal and institutional frameworks and provision of alternatives to antibiotics acted as facilitators to intervention implementation and success. Interventions demonstrated effects in terms of changes in antibiotic use, antibiotic resistance, awareness, and practices, as well as impacts on animal health and productivity. This study highlights the persistent dominance of human health objectives in the design and implementation of One Health antibiotic stewardship interventions and the continuous need to strengthen evaluation of such interventions to better understand facilitators and barriers to their implementation as well as intervention impacts.