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Background Antibiotics have become lynchpins of our modern systems of healthcare, animal health and agriculture. Monitoring the types and volumes of antibiotics distributed, used and discharged across these systems is critical to provide evidence for action. With limited resources, implementation of multiple tools and recommendations for antibiotic monitoring is challenging. This paper sets out the principles and case study illustrations for establishing antibiotic surveillance in resource-constrained settings. Methods A technical working group drew together expertise and experience from around the world and across One Health domains to establish the value of antibiotic surveillance across sectors, review tools and guidelines, share experiences and generate principles for prioritisation of surveillance activity. This included a literature review, in person workshop, online meetings and collaborative writing between August 2024 and May 2025. Results The working group identified multiple purposes for establishing a coordinated antibiotic surveillance within countries, to inform efforts to mitigate antimicrobial resistance (AMR) mitigation efforts and beyond. Tools showed increasing complexity towards the end user level, corresponding with decreasing standardisation in approach. Proposed steps for establishing national antibiotic surveillance included starting where the greatest impact can be anticipated in a given context and alignment with other programmes. Conclusions Countries vary in their agricultural, population, epidemiological, cultural and economic contexts and require different starting points for establishing antibiotic surveillance. This project characterised an action-oriented prioritisation approach, targeting collection and collation of antibiotic data that have the highest likelihood of affecting change that can achieve impact. Such an approach is risk-based, prioritising surveillance of antibiotic use that poses greatest risks as locally defined and is feasible to change; sustainable, aligning local expertise, infrastructure and technology with other country priorities; and transparent, ensuring evidence availability within the system alongside reporting ‘up and out.’ Achieving effective antibiotic surveillance requires a collaborative and coordinated strategy focusing on data for action.

Background: This paper provides the first national analysis of antimicrobial use (AMU) of oral and parenteral dosages in Bangladesh, as well as biannual trends for the years from 2019 to 2023. It also analyzes the effect of the COVID-19 pandemic on AMU. Methods: AMU was analyzed in accordance with the WHO Anatomical Therapeutic Chemical classification and defined daily doses per 1000 inhabitants per day methodology. Data on antimicrobial medicine dispatched from manufacturers’ central warehouse was collected and categorized based on the WHO’s Access, Watch, and Reserve (AWaRe) classification. Findings: This AMU surveillance demonstrates an increase in the use of antimicrobial medicines from 2021 to 2022, and in 2023, it decreased, with our national AMU surveillance data indicating that cefixime and azithromycin were the most consumed antibiotics during this period. Most antibiotics used in Bangladesh are broad-spectrum ‘Watch’-category antibiotics. Among oral antibiotics, 50 to 67% are from the ‘Watch’-category. When considering only parenteral antibiotics, 70 to 91 % fall under the ‘Watch’-category. Third-generation cephalosporin consumption has been found to be higher than second- and first-generation cephalosporins. The oral antimicrobials are more commonly used than parenteral ones. AMU notably increased during the COVID-19 pandemic, especially in the case of systemic antibacterial use. Conclusions: To achieve the global target of 70% use of Access category antibiotics by 2030, the use of Watch-group antibiotics, like cefixime, azithromycin, ciprofloxacin, levofloxacin, and ceftibuten, needs to be reduced through investing in and strengthening stewardship programs and eliminating self-medication in Bangladesh. The findings of this study provide useful information to policymakers to tackle AMR in Bangladesh.

Background: Antimicrobial resistance (AMR) is a critical global health issue. Like other low- and middle-income countries, the misuse of antimicrobial medicine, including widespread self-medication, exacerbates AMR in Bangladesh. Making future generations aware of AMR through educational interventions is an effective tool in combating AMR. This research focuses on understanding the effects of AMR awareness interventions on the knowledge, attitudes, and behaviors of the schoolchildren in the selected district of Bangladesh. Methods: In this study, 241 students of the 12- to 16-year-old age group participated in a two-day program. The programs include four hours of activities, including reading comics and coloring books, presentations, quizzes, and watching an animation about AMR on the first day, followed by an art competition on the second day. To assess changes in knowledge earlier and after the intervention, pre- and post-tests were conducted. Results: This pilot study demonstrates that using age-appropriate interactive educational tools can significantly improve students’ knowledge about AMR, showing a mean difference of 1.28 (p < 0.001). The regulatory step of the Directorate General of Drug Administration, incorporating red identification marks on antibiotic packaging, makes it easier and shows that 93.36% of students could identify antibiotics, which helps them to be aware of these types of medicines. Interventions were equally effective for boys and girls and science and commerce students, and these helped participants recognize the inappropriate practices of antibiotic use in their daily lives. Conclusions: This study identified the importance of incorporating AMR issues into the educational curriculum to address AMR for future generations.