Using ‘smart regulation’ to tackle antimicrobial resistance in low-income and middle-income countries

### Summary box Antimicrobial resistance (AMR) contributes to over 700 000 annual deaths globally. According to the O’Neill report, an estimated 10 million lives a year and a cumulative US$100 trillion of economic output will be at risk by 2050 if we do not put in place proactive solutions now. Tackling AMR is a multifaceted task that requires a One Health approach encompassing human, animal and environmental health as suggested in the WHO’s 2015 Global Action Plan (GAP) on AMR. Countries around the world have aligned their National Action Plans (NAPs) on AMR with this international guidance. One of the important links for various activities for AMR containment is the appropriate use of antibiotics to reduce selection pressure on microbes. In low-income and middle-income countries (LMICs), however, antibiotic consumption rates have been converging towards (and in some countries surpassing) levels typically observed in high-income countries.1 Further, a higher burden of infectious diseases and restricted access to new antibiotics suggest a higher burden of AMR in LMICs than in high-income countries.2 Finally, there is rampant misuse or overuse of antibiotics in humans3 4 and food animals as well as their exposure in the environment.5 6 While the nature of pathways for the emergence and transmission of AMR and the functionality of the regulatory system across various sectors might differ among LMICs, they all face this core public health challenge. There is therefore a pressing need for effective …