The Association Between Antibiotic Misuse and the Development of Antimicrobial Resistance: A Systematic Literature Review

Abstract

The misuse of antibiotics has been widely recognized as a critical driver of antimicrobial resistance (AMR), yet a comprehensive synthesis of evidence across diverse sectors remains fragmented. This systematic literature review was conducted to critically examine the association between antibiotic misuse and the subsequent development of AMR, with particular attention to the underlying drivers, epidemiological patterns, and the effectiveness of interventions. We designed a structured review protocol to identify, appraise, and synthesize empirical studies spanning human medicine, veterinary practice, agriculture, and community settings. The methodology involved a rigorous selection process informed by predefined inclusion criteria, followed by thematic synthesis and quality assessment of included studies. Our results reveal that antibiotic misuse is consistently associated with increased AMR prevalence, with key drivers including inappropriate prescribing behaviors, patient demand, over-the-counter access, and insufficient diagnostic capacity across low-, middle-, and high-income settings. The evidence further indicates that AMR development is not solely a clinical phenomenon but is deeply intertwined with socioeconomic inequalities, regulatory gaps, and political inertia. Consequently, we found that standalone educational campaigns often yield limited impact, whereas integrated stewardship programs coupled with robust surveillance systems demonstrate greater efficacy in curbing misuse. The review also highlights emerging threats from global crises, including pandemics and climate change, which exacerbate existing misuse patterns. We conclude that addressing antibiotic misuse requires a multisectoral, systems-based approach that simultaneously targets behavioral, structural, and policy determinants.