Beyond Antimicrobial Use: A Framework for Prioritizing Antimicrobial Resistance Interventions

Noelle Noyes, Ilya B. Slizovskiy, Randall S. Singer

Research output: Contribution to journalReview articlepeer-review


Antimicrobial resistance (AMR) is a threat to animal and human health. Antimicrobial use has been identified as a major driver of AMR, and reductions in use are a focal point of interventions to reduce resistance. Accordingly, stakeholders in human health and livestock production have implemented antimicrobial stewardship programs aimed at reducing use. Thus far, these efforts have yielded variable impacts on AMR. Furthermore, scientific advances are prompting an expansion and more nuanced appreciation of the many nonantibiotic factors that drive AMR, as well as how these factors vary across systems, geographies, and contexts. Given these trends, we propose a framework to prioritize AMR interventions. We use this framework to evaluate the impact of interventions that focus on antimicrobial use. We conclude by suggesting that priorities be expanded to include greater consideration of host-microbial interactions that dictate AMR, as well as anthropogenic and environmental systems that promote dissemination of AMR.

Original languageEnglish (US)
Pages (from-to)313-332
Number of pages20
JournalAnnual Review of Animal Biosciences
StatePublished - Feb 15 2021

Bibliographical note

Publisher Copyright:
© 2021 Annual Reviews Inc.. All rights reserved.

Copyright 2021 Elsevier B.V., All rights reserved.


  • antimicrobial resistance
  • Antimicrobial use
  • framework
  • livestock

PubMed: MeSH publication types

  • Journal Article

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