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Open research questions in Antibiotic Use and Resistance

68 unresolved questions extracted from the limitations and future-work sections of 699 Antibiotic Use and Resistance papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Research Priorities: Future research must focus on advancing rapid diagnostic tools, developing new antimicrobials, and exploring alternative therapies. Point-of-care diagnostics are particularly important, as they enable clinicians to distinguish bacterial infections from viral ones, thereby reducing unnecessary antibiotic prescriptions. Continued investment in antimicrobial discovery pipelines, especially those targeting Gram-negative pathogens, remains a critical priority for global health. One Health Approach: The One Health framework demonstrates the interdependence of animal, human, and environmental health in tackling AMR. Coordinated surveillance across these domains is essential for tracking resistance determinants and designing effective interventions. Incorporating veterinary and environmental data into public health systems will enhance preparedness and strengthen global capacity to respond to emerging resistance threats. Sustainable Innovation Models: Long-term innovation in combating antimicrobial resistance requires both economic incentives and collaborative frameworks. Approaches such as public-private partnerships, market entry rewards, and subscription-based payment systems are currently being explored to encourage the development of new antibiotics. Global actions, including the Global Antibiotic Research and Development Partnership (GARDP), serve as strong examples of cooperative models that drive progress in this field. Ensuring that new therapies are distributed equitably while upholding stewardship principles will be essential for achieving sustainable outcomes in the fight against AMR [106,107]. Table 8 shows research priorities and innovation models. Table 8.

    Antimicrobial Resistance: Global Threat and Solutions · 2026 · DOI

  • Although CDI outcomes were not directly measured, these prescribing differences may have implications for disparities in CDI-associated harm and warrant further investigation.

    Racial and Ethnic Differences in Exposure to Antibiotics Associated with Clostridioides difficile Infection in US Academic Dental Care · 2026 · DOI

  • Although care home residence is frequently perceived as a risk factor for CPE carriage, its independent association with CPE positivity remains uncertain.

    Care Home Residence and Carbapenemase-Producing Enterobacterales Positivity: A Matched Case-Control Study · 2026 · DOI

  • In these settings, clinicians may have only partial information, limited knowledge of the dental source of infection, and limited capacity to provide drainage or other source-control procedures (34–38).

    Oral health, antimicrobial resistance and the need for interprofessional education · 2026 · DOI

  • Population-level quantitative evidence on healthcare-provider choice and antimicrobial practices in marginalised indigenous communities in low-income and middle-income countries is scarce; most available data are from qualitative studies or administrative records and rarely separate the effects of poverty, education, and community identity, or compare public, private, informal, and non-profit providers within the same population.

    Community identity, poverty, and antimicrobial discontinuation in a Particularly Vulnerable Tribal Group in central India: a cross-sectional study of healthcare choice and differentiated stewardship · 2026 · DOI

  • The Ministry of Health should strengthen supportive supervision and regulation of private hospitals, clinics, pharmacies, and drug shops to ensure rational use of antimalarial medicines. Additional drug inspectors should be recruited and facilitated to strengthen the enforcement of medicine dispensing regulations. Community awareness campaigns should be intensified to educate the public on the dangers of self-medication and the importance of seeking professional healthcare services. Health facilities should be supported to reduce waiting times and improve the availability of essential medicines to minimize reliance on self-medication.

    Antimalarial Self-medication among Adults during the COVID-19 National Lockdown in Northern Uganda: Implications for Antimicrobial Resistance. A cross-sectional study. · 2026 · DOI

  • 2026 Using thirteen identical attitude statements for both groups, the survey revealed that while medical students demonstrated heightened awareness particularly in advocating for responsible antibiotic use and expressing greater personal concern about resistance, both groups shared gaps in understanding its agricultural implications.

    Attitudes of Medical and Non-Medical Undergraduate Students Toward Antibiotic Use and Herbal Medicines in Sulaimani- Iraq · 2026 · DOI

  • The AMR Multi-Partner Trust Fund, established in 2019, provides a mechanism for channeling resources to national programs, but current funding levels are insufficient for the scale of the challenge .

    Antimicrobial Resistance as a Dual Crisis: Evolutionary Biology Versus Global Health Governance · 2026 · DOI

  • Although global antimicrobial resistance strategies increasingly emphasize multisectoral and systems-level responses, the role of administrative and governance-driven interventions within antimicrobial stewardship (AMS) remains relatively underexplored in the literature.

    Administrative interventions in antimicrobial stewardship: a global scoping review of all WHO regions · 2026 · DOI

  • Our study has certain limitations. Since the prescribing antibiotics pattern was investigated in a single hospital, the results of the study cannot be generalized to all hospitals, and as this study was conducted among inpatients, it does not represent outpatients. The present institution was a government hospital, and the prescription pattern depends on the government supply of drugs. In this study, all the clinical departments of the institution were not included, especially super-specialty departments. www.wjpr.net │ Vol 15, Issue 12, 2026. │ ISO 9001: 2015 Certified Journal │ 719 Syeda et al.

    THE ANTIBIOTIC CONUNDRUM AND ANTIMICROBIAL STEWARDSHIP: AN OBSERVATIONAL STUDY ON PRESCRIBING PATTERN OF ANTIBIOTICS IN A TERTIARY CARE TEACHING HOSPITAL · 2026 · DOI

  • This review has several strengths. It is, to our knowledge, the first scoping review to comprehensively map CHV-led AMR interventions across SSA within an explicit One Health framework. The use of the PRISMA-ScR reporting standard enhances transparency and reproducibility. The inclusion of both peer-reviewed literature and grey literature is essential in a field where significant programmatic evidence exists outside traditional academic publication channels. The breadth of intervention types captured provides a genuinely comprehensive evidence landscape. Limitations include the inherent heterogeneity of scoping reviews, which precludes formal meta-analytic synthesis. The language restriction to English and French may have excluded relevant evidence from Lusophone SSA countries. Publica- tion and reporting bias may affect the peer-reviewed literature. As a scoping review, our findings map the landscape rather than providing definitive effectiveness estimates; a systematic review with meta-analysis would be a valuable next step as the evidence base matures. Furthermore, it should be explicitly acknowledged that whilst CHVs are well positioned to deliver human health-focused AMR interventions, they are generally less equipped, in terms of training, mandate, and resources, to address agricultural, environmental, and animal health dimensions of AMR. Realising the One Health potential of CHV programmes will therefore require substantially more integrated training, cross-sectoral collaboration, and dedicated resourcing than has been documented to date in SSA. The date restriction to January 2018 onwards, whilst justified by the post-UNGA 2016 AMR policy context, is acknowledged as a limitation that may have excluded earlier community-level evidence. Also, the recommendations herein are limited by the complex context of AMR interventions in LMICs, where Pokharel et al. [52] point out that the high burden of infectious diseases, extensive poverty levels, weak health systems, and low awareness of AMR continue to hinder the fight against AMR. There are also power differences, PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0006640 June 11, 2026 14 / 18 alignment of interests, poverty, and vulnerability, which may be systemically embedded and may not be amenable to CHW interventions [50].

    Community health volunteers as a frontline platform for antimicrobial resistance mitigation in sub-Saharan Africa: A scoping review · 2026 · DOI

  • To strengthen its AMR governance, Nigeria must act decisively on several fronts. Foremost, it should leverage its hosting of the 2026 Global AMR Conference to champion a measurable "Abuja Outcome Document" and a transparent annual AMR scorecard (Adepoju et al., 2025). Concurrently, it must develop a sustainable financing strategy that mobilizes domestic resources and explores mechanisms like an African AMR financing facility (Adepoju et al., 2025). Implementation requires integrating stewardship into existing health and agriculture programmes, investing in subnational laboratory and human resource capacity, and institutionalizing One Health coordination beyond high-level committees to operational levels. These actions are essential to transform Nigeria's AMR governance from aspiration into an effective, actionable system.

    Comprehensive Review: Governance of Antimicrobial Resistance in Nigerian Healthcare Settings · 2026 · DOI

  • the The data reveals the profound and multi-dimensional impact of Antimicrobial Resistance (AMR) in Nigeria. According to the World Health Organization (2025, November 25), AMR was directly responsible for 64,500 deaths in Nigeria in 2021, with an additional 263,400 associated deaths linked to the crisis, representing a leading cause of mortality within the country. The economic consequences are equally severe, with AMR reducing Nigeria's national Gross Domestic Product by an estimated 7% and causing an 11% decline in livestock productivity, undermining both national development and food security (World Health Organization, 2025, November 25). When viewed in a global context, the scale of Nigeria's challenge is part of a worldwide emergency; in 2025, global AMR direct deaths were reported at 1.27 million annually, with associated deaths reaching 5 million each year (World Health Organization, 2025, November 25). These statistics underscore the silent pandemic of AMR as a critical threat to public health and economic stability both within Nigeria and across the globe.

    Comprehensive Review: Governance of Antimicrobial Resistance in Nigerian Healthcare Settings · 2026 · DOI

  • Standalone noninferiority trials for any single resistance cat- egory would require approximately 4,000 patients per arm. The most realistic path forward is the BALANCE + adap- tive platform trial [34], which could incorporate resistance- stratified duration domains into its existing multi-center infrastructure. The SHORTEN-2 trial [32] may contribute specific evidence for P. aeruginosa BSI. In the interim, pooling individual patient data from the four definitive RCTs with resistance-level microbiological data could pro- vide preliminary resistance-stratified estimates.

    Seven versus fourteen days for resistant bloodstream infections: what do we actually know? A scoping review · 2026 · DOI

  • in animaland resistance genes bacteria breeding environments. J Vet Med Sci. 2022； 84（9）：1292―8. 60）Azuma T, Usui M, Hasei T, Hayashi T：Distribution of antimicrobials, antimicrobial-resistant bacteria, and their genes in hospital effluents, wastewater treatment plants, and receiving rivers of urban river basins in Japan. J Environ Chem Eng. 2026；14（1）：120605. 61）Baba H, Nishiyama M, Watanabe T, Kanamori H：Review of antimicrobial resistance in wastewater in Japan：Current challenges and future perspectives. Antibiotics (Basel). 2022；11（7）： 849.

    Historical Evolution of Antimicrobial Resistance (AMR) and Public Health Challenges in Japan · 2026 · DOI

  • Street vendors sell medicines at a market in Abobo, Côte d’Ivoire. SELLING ANTIBIOTICS DOWN THE RIVER Untrained market vendors and patient-pleasing private physicians are fuelling overuse of crucial drugs. By Ben Deighton S8 | Nature | Vol 653 | 14 May 2026 Y T T E G A I V P F A / O G O N A S F U O S S I At Ghana’s biggest hospital, even the strongest antibiotics are starting to fail. A big part of the reason is the rampant overprescription and over- use of these drugs in the West African country of 35 million people. Because many Ghanaians lack access to physicians, those who fall ill often end up buying antibiotics from unauthorized sellers instead. “We have people who go around car- rying all sorts of things, who would mix them as concoctions and give them to patients who have no clue what is going on,” explains Antoinette Bediako-Bowan, a surgeon at the Korle Bu Teaching Hospital in Accra. By the time a person presents at the hospital, “they really have taken quite a number of antibiot- ics”, Bediako-Bowan says. Such liberal use of the drugs gives bacteria the opportunity to adapt, driving resistance. The World Health Organization (WHO) divides antibiotics into three categories under its Access, Watch and Reserve (AWaRe) system. Access antibiotics are used against common infections, watch antibiotics can fight a wider range of bacteria and reserve antibiotics are held back for the most dan- gerous pathogens. Bediako-Bowan says that in the hospital where she works, around 60% of patients have infections that can resist common access anti- biotics, such as penicillins and first-generation cephalosporins. More worryingly, she says, around 4% of these are resistant to carbapen- ems, which are on the watch and reserve lists. Carbapenems are often the strongest option available in Bediako-Bowan’s hospital, so “even a small percentage is a big thing”. In 2023, according to the WHO, one in six laboratory-confirmed bacterial infections worldwide were caused by bacteria that are resistant to antibiotics1. The burden of antibiotic resistance is highest in low- and middle-income countries (LMICs), and grow- ing rapidly. Between 2018 and 2023, resistance to imipenem — a carbapenem antibiotic — in Acinetobacter bacteria grew faster in the east- ern Mediterranean and in southeast Asia than it did anywhere else. These Gram-negative bacteria (a typing that also applies to other stubborn foes such as Escherichia coli and Klebsiella pneumoniae) are a common cause of hospital-acquired bloodstream infections. “When resistance to carbapenems is encountered, treatment options for Gram-negative bacterial pathogens are often limited to antibiotics in the AWaRe reserve group, which are frequently unaffordable, more toxic, inconsistently available and require diagnostic confirmation that is rarely feasible in resource-limited settings,” says Silvia Bertagnolio, head of the WHO’s anti- microbial resistance surveillance, evidence and laboratory strengthening unit in Geneva, Switzerland. Deaths attributable to antimicrobial resist- ance occur around the world (see ‘A global threat’). But they are close to twice as com- mon in West Africa, at around 20 per 100,000 people, as they are in high-income countries of North America and Europe, according to data from the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. Antibiotic overuse is driven by unlicensed street sellers, improperly trained pharmacists and physicians who overprescribe medicines to keep their patients happy, as well as by a lack of access to diagnostic tests. Global-health specialists are trying to tackle the problems through a variety of means, including educa- tion programmes, smartphone apps and even investigations involving undercover patients.

    Street sellers and private physicians fuel antibiotic overuse · 2026 · DOI

  • This study has some limitations that should be considered when interpreting the findings. First, although systematic random sampling was used, the replacement of households when no eligible respondent was present may have introduced selection bias, as individuals who were absent at the time of data collection may differ systematically from those available, particularly in terms of mobility and healthcare utilization patterns. Second, the reliance on self-reported data for assessing unused medicines may have introduced recall bias and social desirability bias, potentially affecting the accuracy of responses. Third, the exclusion of informal settlements and households that declined to allow verification of medication labels may have introduced selection bias. Such households may differ systematically from those included, particularly if they are more likely to possess informally obtained or improperly stored medications, potentially leading to an underestimation of the true prevalence of unused medicines. However, label verification was necessary to ensure accurate identification and classification of medications and to minimize recall bias. Additionally, the cross-sectional design limits causal ARTICLE IN PRESS ARTICLE IN PRESS ACCEPTED MANUSCRIPT ARTICLE IN PRESS inference, and findings may not be fully generalizable to all IDP settings, particularly unregistered or informal settlements.

    Unused medicines among households in internally displacement (IDP) camps in Ethiopia: an explanatory sequential mixed-methods study · 2026 · DOI

  • A key strength of this study lies in the inclusion of diverse stakeholder groups, which enabled a multi-level understanding of unused medicine management from community, professional, and policy perspectives. The qualitative design, combined with separate focus group discussions, allowed for the exploration of context-specific barriers and facilitators that may not be captured through survey-based approaches. However, several limitations should be considered. First, this study was conducted in a single regency in West Java, and the findings may not be fully transferable to other regions of Indonesia with different sociocultural contexts, geographic characteristics, and healthcare infrastructures, such as those in Eastern Indonesia. These contextual differences may influence both access to services and community practices related to medicine use and disposal. Second, as the study primarily involved institutional stakeholders, the findings may reflect organisational and professional perspectives more strongly than those of the general community. While these stake- holders interact closely with the public, their views may not fully capture the lived experiences and decision-making processes at the household level. Finally, although the socio-ecological model provided a useful framework for organising the findings, it may simplify the complex and dynamic interactions between levels of influence. In particular, the model does not capture the relative weight or power of different factors, nor how these may shift across contexts, which may limit its ability to fully explain causal relationships.

    Views, Barriers and Facilitators of Policymakers, Pharmacists and Community Health Representative in Managing Unused Medicine in a Socioeconomically Diverse District in Indonesia · 2026 · DOI

  • The administration of antibiotics in the NICU varies widely, and inappropriate use can cause resistance, underscoring the need to monitor rationale use through an antimicrobial stewardship program.

    Quantitative and qualitative analysis of antibiotic use among neonatal patients in teaching hospitals in Indonesia · 2024 · DOI

  • OBJECTIVES: To date, there is a lack of data regarding the acceptance of the guidelines for infective endocarditis (IE) prevention among dentists in Italy, and similarly, there are no data on the understanding and compliance of those among dental hygienists (DH).

    Assessment of the current knowledge about infective endocarditis prevention among dental hygienists in Italy: A national survey · 2023 · DOI

  • Lack of evidence for change, such as shortening duration of therapy, may also be negatively impacting reflective motivation and fear of deterioration is often cited as a barrier to AMS.

    Challenges to appropriate antimicrobial use in horses · 2023 · DOI

  • Although countries around the world have committed to developing and implementing national action plans to tackle ABR, there is a considerable gap in evidence about effective behaviour change interventions addressing inappropriate use of antibiotics in low- and middle-income countries (LMICs), where ABR is growing at an alarming rate.

    Improving antibiotic use through behaviour change: a systematic review of interventions evaluated in low- and middle-income countries · 2021 · DOI

  • CONCLUCIONS: The obtained results show that patients have basic information about gastro-enteroprotective agents (including drugs that reduce the production of hydrochloric acid from the group of proton pump inhibitors and probiotics) however their knowledge is still insufficient to guarantee the effectiveness of therapy.

    The role of protective agents in pharmacotherapy- assessment of patients awareness · 2019 · DOI

  • Purpose Drawing insights from the culture-centered approach (Dutta-Bergman, 2004; Dutta, 2007), the purpose of this paper is to explore the meanings of, experiences with, and information sources for antibiotics among at-risk yet understudied populations in urban and economic margins in the Global South.

    Antibiotic-related meanings, experiences and information sources of women in the economic margins of urban Manila · 2018 · DOI

  • These studies offer some support for the argument that the risks of resistant infections are being discussed outside the medical profession and may be used in stewardship messages, even when the mechanisms of AMR are not well understood (Wellcome 2016).

    Editorial: Beyond behavior? Institutions, interactions and inequalities in the response to antimicrobial resistance · 2018 · DOI

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