A COMPREHENSIVE REVIEW OF ANTIMICROBIAL RESISTANCE BEGINNING FROM THE DISCOVERY OF THE FIRST ANTIBIOTIC UNTIL THE PRESENT-DAY SITUATION WITH ONE HEALTH APPROACH WITH SPECIAL EMPHASIS ON BANGLADESH
Authors: Samad M. A. 
Published: September 2024

Background:	Antimicrobial resistance (AMR) has become an emerging multifactorial and complex issue globally in both livestock and public health, especially more health risk in low-income countries including Bangladesh. The antibiotic-resistant bacteria (ARB) and antibiotic resistance gene (ARG) that confer resistance are transmitted and circulated within humans, animals, and the environment. Both the complex AMR and ‘One Health’ connect humans, animals, and the environment, which needs to be effectively addressed in all three interconnected domains of health. This article gives a comprehensive review of the antibiotic era, beginning from the discovery of the first antibiotics until the present-day situation including multidrug resistance (MDR) status with special reference to Bangladesh within the ‘One Health’ concept.
Objectives: This comprehensive review was carried out to describe an updated overview of AMR and associated risk factors in livestock and human health within one health approach in Bangladesh.
Methods: Review and research articles (n = 315) related to AMR published from Bangladesh (n = 156) and elsewhere (n = 159) in English language have been reviewed through Google search including, Cross-Ref, PubMade, and Bangladesh Journals online by using possible relevant keywords to identify the articles. Findings of antibiotic discovery and mode of action, development of resistance and its mechanism, drivers and risk factors, and measures against AMR including the ‘One Health’ approach have been reviewed and analyzed
Results: This review of AMR beginning from the discovery of the first antibiotic penicillin until the present-day situation with the ‘One Health’ approach has been reviewed based on 315 published research reports and their data are analyzed and presented in 51 tables with a high prevalence of AMR in both human and veterinary medicine and their results are discussed. Antimicrobials have diverse applications in different fields including aquaculture, livestock and crop production, and the prevention and treatment of human and livestock diseases, and overuse and misuse of antibiotics lead to the development of antibiotic-resistant bacteria that persist in the affected hosts and their environment. These resistant bacteria are shared between livestock and humans through food and environmental exposure. These resistant bacteria usually persist and circulate through contaminated environments associated with a significant threat to human and animal health. The antibiotic-resistant bacteria contain resistant genes that act as primary drivers (risk factors) which can transfer naturally or through human activities. Surveillance and rapid detection of antimicrobial-resistant bacteria are essential for judicious use of appropriate antibiotics only when necessary and preventing transmission of resistant bacteria will certainly help to prevent the AMR.
Conclusions: A high prevalence of AMR, especially in most antibiotics, has been reported from Bangladesh with limited routine antibiogram surveillance reports. Although 178 countries have developed national action plans, fewer than a fifth are funded or implemented. However, several international organizations including WHO, FAO, and World Organization for Animal Health (WOAH/OIE) have now included a ‘One Health’ approach within their action plans to address AMR, which action program would be required in medium and low-income countries including Bangladesh where the highest percentage of AMR occurs in both human and veterinary patients. The ‘One Health’ approach is important for AMR because resistant pathogens can spread quickly through livestock and human healthcare facilities, food, and environment (soil and water), making the treatment and prevention of certain infections shared between livestock and humans more challenging, and increasing the risk of disease spread, severe illness, and death. The judicial use of antimicrobials based on better regulation and policy, improved surveillance, stewardship, infection control, livestock husbandry practices, and finding new antibiotics and alternatives to antimicrobials including vaccines should be included in the action plan to prevent and spread the AMR in the environment. It may be concluded that the collaboration among human, livestock, and environmental health sectors by adopting a ‘One Health’ approach is important to achieve sustainable and long-lasting results.