Antimicrobial Resistance: A Growing Global Public Health Emergency — A Narrative Review of Epidemiology, Drivers, and Strategies for Mitigation
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Abstract
Background: Antimicrobial resistance (AMR) is ranked by the World Health Organization (WHO) among the top ten global public health threats. In 2019, bacterial AMR was associated with an estimated 4.95 million deaths worldwide and was the direct cause of 1.27 million deaths, surpassing HIV/AIDS and malaria combined as a cause of death. Updated 2024 modelling suggests the annual toll now exceeds one million directly attributable deaths and could cumulatively reach 39 million deaths between 2025 and 2050 without intensified action.
Objective: This narrative review synthesizes current, peer-reviewed and official evidence on the global epidemiology, principal drivers, and health-economic consequences of AMR, and critically evaluates the effectiveness of existing surveillance, stewardship, and policy responses.
Methods: A narrative literature review was conducted using PubMed, Web of Science, Google Scholar, and the official repositories of WHO, the US Centers for Disease Control and Prevention (CDC), the World Bank, and the United Nations, covering publications and official reports from 2015 to 2025. Search terms combined “antimicrobial resistance” or “antibiotic resistance” with terms denoting burden, surveillance, stewardship, One Health, and economic impact. Priority was given to systematic reviews, meta-analyses, large multi-country modelling studies, and official global reports.
Results: AMR burden is driven by overlapping human, agricultural, and environmental factors, including inappropriate antibiotic prescribing, weak infection prevention and control, and the substantial and rising use of antimicrobials in food-animal production. The World Bank estimates that unmitigated AMR could reduce global GDP by up to 3.8% and push tens of millions of people into poverty by 2050. The antibiotic development pipeline remains thin and fragile: as of 2025, only 90 antibacterial agents were in clinical development, of which just 15 were classified as genuinely innovative, and the sector remains dependent on small, poorly capitalized biotechnology firms. Antimicrobial stewardship programmes reliably reduce antibiotic consumption (by roughly a quarter on average) but the evidence that stewardship alone measurably reduces resistance rates is more limited and heterogeneous. Global governance has strengthened through the WHO Global Action Plan, the GLASS surveillance system, the 2024 WHO Bacterial Priority Pathogens List, and a 2024 United Nations political declaration committing to a 10% reduction in AMR-associated deaths by 2030, but financing and surveillance capacity remain especially weak in low- and middle-income countries, which bear the highest mortality burden.
Conclusion: AMR is an accelerating but not inevitable crisis. Meeting internationally agreed 2030 targets will require sustained, multisectoral One Health investment that combines stewardship, infection prevention, equitable access to effective antimicrobials, strengthened surveillance, and re-engineered incentives for antibiotic research and development.
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