Community Antibiotic Access Pathways at Human-Animal-Environmental Interfaces: A One Health Systematic Review of Drivers of Antimicrobial Resistance in Low-Resource Settings

Abstract

Background: Antimicrobial resistance (AMR) is one of the gravest threats to the global health in the twenty-first century, which is disproportionately straining low- and middle-income nations (LMICs). The human animal-environment interface is unregulated by the flow of antibiotic residues, resistance genes, and resistant organisms. In a One Health approach, this systematic review will present the information of 2020-2025 on the community-level pathways of access to antibiotics and the factors associated with AMR in low-resource areas.

Methods: It was searched thoroughly in PubMed/MEDLINE, Google Scholar, Web and also in the WHO Global AMR Databases. They included studies on the access mechanisms, use patterns and AMR drivers in human-animal-environmental interactions of LMICs published within the time period of January 2020 to December 2025. The PRISMA 2020 guidelines were adhered to. Independent review found 26 studies that qualified as per the inclusion criteria.

Results: The four interrelated driver domains that were discovered to be community access points to antibiotics; mainly unregulated over-the-counter (OTC) dispensing; agricultural and veterinary antibiotic usage with a lack of control; environmental contamination with pharmaceutical residues, wastewater, and livestock effluents; and structural, socioeconomic and governance failures. Approximately 80% of Antibiotics in LMICs are used at community levels and one-fifth to half is misused. The WHO AWaRe criteria of 70% Access antibiotic use was only met by 14% of studies.

Conclusions: There is an economic constraint, weak implementation of the regulations and gaps in the provision of healthcare, which play a pivotal role in the access routes of antibiotics in the communities of LMICs. Coordinated, compassionate, equity-focused One Health approaches that recognize the lived reality of communities on the front lines of this crisis are necessary to address AMR.