Tetracyclines are among the oldest classes of antibiotics, with broad activity against Gram-positive and Gram-negative bacteria, as well as Chlamydia, Legionella, Rickettsia, and Mycoplasma species. Widely used in human and veterinary medicine, agriculture, and aquaculture, they represent approximately 10–12% of the global antimicrobial market. Extensive use has driven the emergence and spread of antimicrobial resistance, posing ecological and public health risks. However, the full extent of these risks remains unclear due to limited data on tetracycline consumption, environmental occurrence, and resistance patterns across sectors. Recent One Health-oriented strategies have promoted the rational use of tetracyclines in medicine, veterinary practice, and agriculture. To reduce environmental accumulation, various degradation and remediation techniques have been developed, though most remain restricted to laboratory or engineered settings. This narrative review provides a comprehensive overview of global tetracycline consumption; environmental occurrence; distribution and concentration levels; resistance mechanisms and prevalence; and mitigation strategies, including antimicrobial stewardship and degradation approaches. Understanding these aspects is essential for developing evidence-based interventions to minimize the environmental and public health impacts of tetracycline use.

During the COVID-19 pandemic, a ban on inspections of small businesses, including pharmacies, was imposed in Kazakhstan, which relaxed law enforcement efforts regarding the prohibition of over-the-counter antibiotic (AB) sales. This study aimed to investigate how this affected the knowledge, attitudes, and practices (KAP) related to AB and antimicrobial resistance (AMR), as well as to assess actual AB consumption at the community level. The study comprised two cross-sectional sub-studies: the first involved a KAP survey conducted in 2022 and 2024, utilizing the Special Eurobarometer questionnaire on AMR. The second sub-study analyzed AB consumption in 2021 and 2023, measured in defined daily doses per 1000 inhabitants. Results revealed an increase in the percentage of individuals reporting receipt of information about ABs and AMR in the past year (37.3% in 2022 vs. 52.9% in 2024, p < 0.001) and an increase in the percentage of individuals reporting AB use in the past year (49.0% in 2022 vs. 54.0% in 2024, p = 0.056). The most consumed ABs were from the Watch group, with azithromycin and ceftriaxone ranking highest. These findings support the hypothesis that the relaxation of law enforcement contributed to an increase in AB consumption and emphasize the need for public health policies to address this issue.

Background/Objectives: There has been a lack of a holistic approach to evaluating antibiotic consumption in Kazakhstan over the past few years using an internationally recognized methodology. Therefore, this study aimed to provide a nationwide evaluation of antibiotic consumption in Kazakhstan during the period 2019–2023. Methods: Defined daily doses per 1000 inhabitants per day (DIDs) were calculated for systemic antibiotics (J01 code of the Anatomical Therapeutic Chemical Classification System (ATC)) following the methodology established by the Global Antimicrobial Resistance and Use Surveillance System (GLASS-AMC). The average annual percent change (AAPC) was computed for each chemical agent, pharmacological group, and J01 in general to evaluate past trends in antibiotic consumption. Results: The consumption of J01 antibiotics ranged between 10.869 DIDs (2022) and 14.470 DIDs (2020). There was an increase in antibiotic consumption during 2020 and 2021, but the overall trend was declining, with an AAPC of −2.45%. Azithromycin was the most consumed systemic antibiotic, followed by ceftriaxone and ciprofloxacin. The consumption of “Watch” group antibiotics prevailed in Kazakhstan during the study period, with the number of people consuming the top five “Watch” group antibiotics rising from 72,578 in 2019 to 94,617 in 2023. Conclusions: The findings of this study are crucial for the reorganization of the national antimicrobial stewardship program.

Background/Objectives: Few studies have examined the prevalence of healthcare-associated infections (HAIs) and antimicrobial use (AMU) in acute care hospitals in Kazakhstan. This study aimed to address this gap by conducting a point-prevalence survey (PPS) of HAIs and AMU, as well as evaluating hospital antibiotic consumption via internationally recognized methodologies. Methods: PPS was conducted in four acute care hospitals in Kazakhstan on 11 May 2022, following the methodology of the European Center for Disease Prevention and Control, and included 701 patients. Antibiotic consumption in the same hospitals was assessed via the Global Antimicrobial Resistance and Use Surveillance System methodology. Results: HAIs were observed in 3.8% of patients (27/701), with intensive care unit wards accounting for 48.1% of these cases (13/27). Pseudomonas aeruginosa was the most frequently identified pathogen (5 out of 14 documented cases, 35.7%). Resistance to carbapenems was the most common resistance, followed by resistance to glycopeptides and third-generation cephalosporins. The rate of AMU was 38.2%, with an average of 1.37 antibiotics administered per patient. Surgical prophylaxis lasting more than one day was the most common indication for antimicrobial prescription (44.8%). Ceftriaxone and cefazolin are the most commonly used antibiotics. Conclusions: The results of this study are important for understanding the current situation in Kazakhstan and for informing national antimicrobial stewardship and infection control strategies.

Background/Objectives: This study aims to analyze antibiotic consumption trends from 2014 to 2023 in Kazakhstan, Kyrgyzstan, Tajikistan, and Russia; forecast future trends up to 2030; and identify key social and economic factors influencing antibiotic use. Methods: Data on antibiotic consumption were obtained from the World Health Organization Regional Office for Europe Antimicrobial Consumption Network. Social and economic indicators were sourced from the World Bank DataBank. Of the 86 factors initially considered, 35 were included in the analyses. The forecast modeling of antibiotic consumption trends until 2030 and linear regression analysis to assess associations between antibiotic consumption and its predictors were conducted via SPSS. Results: The lowest antibiotic consumption rates were observed in Kazakhstan and Russia, whereas Kyrgyzstan and Tajikistan presented higher rates. The projected antibiotic consumption rates are expected to decline only in Kazakhstan, with other countries remaining stable. Birth and death rates, as well as under-five mortality rates, were significant determinants of antibiotic consumption in Kazakhstan and Tajikistan. In Russia, per capita GDP was a key determinant, whereas in Kazakhstan, inflation in consumer prices played a significant role. Additionally, cereal production was significantly associated with antibiotic consumption in Kazakhstan. In Kyrgyzstan and Russia, measles immunization rates were important determinants, whereas in Kyrgyzstan, access to clean fuels and technologies for cooking was significantly associated with antibiotic consumption. Conclusions: The findings of this study provide valuable insights for strengthening antimicrobial stewardship programs by addressing key social and economic determinants of antibiotic use.

Background/Objectives: This study aimed to analyze the consumption of systemic antibacterials (WHO ATC J01) in primary care in Kazakhstan from 2017 to 2024 and to estimate the potential contribution of different primary care providers to the use of “Watch” and “Reserve” antibiotics. Methods: The Global Antimicrobial Resistance and Use Surveillance System methodology was applied to calculate defined daily doses per 1000 inhabitants per day (DID) for ATC J01 overall, as well as at ATC levels 3 and 5. Forecast modeling was performed using ARIMA (0,1,0), ARIMA (0,0,0), and Simple models to project trends through 2030. Pearson’s correlation was computed for each category of primary healthcare provider and each chemical agent belonging to the “Watch” and “Reserve” groups. Results: Antibiotic consumption increased by approximately 1.5 times in 2024 after remaining relatively stable from 2017 to 2023. The forecasts suggest that the share of “Access” group antibiotics will continue to decline, reaching 33.71% by 2030, whereas the share of “Watch” group antibiotics is expected to increase proportionally, reaching 65.73% by 2030. The per capita densities of primary care providers correlate with the consumption of certain “Watch” and “Reserve” group antibiotics. Conclusions: This study demonstrates that the primary care sector in Kazakhstan is characterized by a disproportionately high and increasing use of “Watch” antibiotics, a rising trend in “Reserve” antibiotic consumption, and a declining share of “Access” antibiotics. These findings highlight a need to prioritize stewardship interventions that target the reduction in “Watch” and “Reserve” antibiotics, while promoting the use of “Access” antibiotics.