When most people hear “antimicrobial resistance,” they picture a hospital ward: a patient not responding to antibiotics, a doctor reaching for a second- or third-line drug, a pharmacist quietly worried about what happens when even that stops working. It's a fair image — but it's an incomplete one. Antimicrobial resistance (AMR) doesn't begin or end at the pharmacy counter. It moves through farms, rivers, soil, food chains, and ecosystems long before — and long after — it ever reaches a prescription pad.
As a pharmacist, I spend my days thinking about correct dosing, appropriate drug selection, and stewardship within our hospital. But the more I've studied AMR, the clearer it has become that clinical practice is only one front in a much larger battle. If we want to preserve the antimicrobials that keep modern medicine functioning, we have to look beyond the prescription and understand resistance as a problem that spans humans, animals, agriculture, food systems, and the environment. This is what global health experts call the One Health approach, and it is no longer optional thinking. It is the only thinking that matches the scale of the problem.
Start with human medicine, where the pressures are familiar: Over-prescription, patients stopping courses early, and — especially across much of the world, including Kenya — the ease of buying antibiotics over the counter without a prescription at all. Every unnecessary or incomplete course gives resistant bacteria room to survive and multiply. This is the piece of AMR most people have heard about, and rightly so — but it is genuinely just the beginning.
Move next to animal agriculture where antimicrobial use dwarfs human consumption globally. Antibiotics are routinely administered to livestock and poultry not only to treat disease but to promote faster growth and compensate for crowded, stressful farming conditions. Resistant bacteria that develop in animals don't stay contained — they pass to farm workers, spread through animal waste, and travel into water systems and soil.
Agriculture adds another layer that receives far less public attention: The use of antifungal compounds on crops, particularly to protect cereal and fruit harvests. Some of these compounds are chemically close cousins of antifungal drugs used in human medicine. There is now real concern that agricultural fungicide use is contributing to resistant Aspergillus infections in humans — a quietly emerging crisis in an area few patients would ever think to connect to their farm's pesticide schedule.
Food systems are where these threads visibly converge. Resistant bacteria can travel from farm to fork through meat, dairy, and fresh produce, especially where food safety infrastructure and cold chains are inconsistent. A resistant infection doesn't need a hospital to spread — it can arrive at the dinner table.
And then there is the environment — arguably the least visible link, and the one I think deserves far more attention than it currently receives. Pharmaceutical manufacturing effluent, hospital and municipal wastewater, and agricultural run-off all carry antibiotic residues and resistant organisms into rivers and soil. These environmental reservoirs don't just passively hold resistance — they actively allow bacteria to exchange resistance genes with one another, effectively training the microbial world to out-manoeuvre our best drugs, often far from any clinic.
So what do we do with this bigger picture?
We need surveillance systems that track resistance across all these sectors, not just hospitals. We need veterinary and agricultural stewardship programmes with the same seriousness we apply to clinical antibiotic use. We need investment in wastewater treatment and pharmaceutical manufacturing controls. We need continued investment in new antimicrobials, rapid diagnostics, and vaccines — because prevention is always cheaper than resistance. And we need public understanding that AMR is not a distant, abstract threat, but a consequence of choices made across an entire food and health system, many of which happen far from any doctor's office.
As a pharmacist, I will keep doing my part at the prescription counter — because stewardship there still matters enormously. But I've come to believe that the next chapter of this fight will be won or lost in places most of us never think to look: A poultry farm, a fungicide spray, a river downstream of a manufacturing plant. AMR is, quite literally, everyone's problem. Treating it as only a medical one is how we lose.
Ms Anand is Chief Pharmacist, The Nairobi Hospital
