Researchers led by Oluwawemimo Adebowale of the Federal University of Agriculture, Abeokuta, surveyed 48 integrated farms in Lagos and Ogun states between May and September 2023, using structured interviews with farmers alongside on-site assessments of biosecurity. The results, published in BMC Agriculture, offer the first baseline data on antimicrobial use in this emerging Nigerian farming system, and they reveal a landscape of heavy antibiotic reliance, patchy disease prevention, and knowledge gaps that could accelerate the global crisis of antimicrobial resistance.

The scale of drug use on these farms is striking. Farmers reported deploying at least ten different classes of antibiotics, including fluoroquinolones, tetracyclines, macrolides, aminoglycosides, penicillins, sulphonamides, lincosamides, cephalosporins, nitrofurans, and polymyxins. In poultry, the most commonly used drugs were enrofloxacin, reported by 89.4 percent of farmers, oxytetracycline at 80.9 percent, doxycycline and tylosin at 78.7 percent, and colistin at 63.8 percent. For fish, oxytetracycline and enrofloxacin dominated. Many of these compounds fall into the World Health Organization’s highest priority critically important antimicrobials for human medicine, meaning they are drugs on which doctors depend when other treatments fail. Colistin, a polymyxin widely used on the surveyed farms, is considered a last-resort antibiotic in human medicine, reserved for infections that no other drug can touch.

The WHO classifies antibiotics into three stewardship tiers known as AWaRE: Access, for first-line drugs with low resistance risk; Watch, for broader-spectrum drugs that require careful monitoring; and Reserve, for last-line treatments. The study found that farmers were using drugs from all three groups, including Watch and Reserve categories, often without veterinary oversight. Nearly 96 percent of farmers purchased antimicrobials from veterinary pharmacies, and 79.2 percent used them to prevent disease rather than to treat diagnosed infections, a practice that blankets healthy animals in drugs and creates intense selection pressure for resistant microbes.

The biology of the integrated system amplifies the risk. When poultry droppings containing antibiotic residues and resistant bacteria wash into fish ponds, the aquatic environment becomes a mixing vessel where resistance genes can move between bacterial species. A previous Nigerian study cited by the researchers confirmed that multidrug-resistant gram-negative bacteria from chicken excreta were disseminating into pond environments and fish. Because bacteria readily exchange resistance genes through horizontal gene transfer, a pond fertilized with medicated poultry waste is essentially an evolutionary accelerator. Fish raised in that water, and inadequately cooked before consumption, can carry resistant pathogens to the dinner table.

Disease pressure on these farms helps explain the drug dependence. Chronic respiratory disease was the most commonly reported chicken ailment, affecting 68.8 percent of farms in the previous year, followed by infectious coryza and bacterial gastroenteritis from salmonellosis and colibacillosis. Among fish, fin rot was the leading complaint. Yet the study found that preventive measures were applied unevenly: nearly all farmers vaccinated and dewormed their chickens, but fewer than one in ten reported routine vaccination of fish, leaving aquaculture largely unprotected and dependent on reactive drug use when outbreaks struck.

Biosecurity, the frontline defense that reduces the need for antibiotics in the first place, was found wanting. Only 54.1 percent of farms had established biosecurity protocols at the time of the visit, and field assessors judged just 37.5 percent of farmers as having good biosecurity measures in practice. The overall biosecurity score averaged 64.7 percent, with more than half of participants rated as poor. Two-thirds of farms reported migratory wild birds on the premises, a known vector for disease introduction, while fewer than a third had designated biosecurity work zones separating clean and dirty operations. In a system where poultry and fish share water, waste, and space, such lapses leave multiple doors open for pathogens.

Perhaps the most encouraging finding is that knowledge and attitude appear to be levers for change. Farmers’ knowledge of antimicrobial use correlated positively with their actual practices, as did their attitudes, and the two were strongly linked to each other. Farmers who understood the risks tended to think differently about drugs, and farmers who thought differently tended to use them more responsibly. More than 94 percent of respondents said they were willing to attend training on appropriate antimicrobial use, with workshops, seminars, and veterinary extension officers identified as the preferred channels. The farmers themselves identified the main drivers of indiscriminate drug use as lack of awareness and training, quackery, inadequate access to veterinary services, weak antibiotic policy enforcement, and poor biosecurity.

The study’s authors are careful to note its limits. The sample of 48 farms is small, reflecting the fact that integrated fish-chicken farming is still an emerging system in Nigeria, and the findings may not generalize to the entire country. The survey also relied on self-reported data and did not directly test for resistant bacteria on the farms, which the researchers flag as a priority for future work using microbiological and genomic methods. Still, the correlations they documented, however modest in magnitude, point to a clear intervention strategy: educate farmers, strengthen biosecurity, and the demand for antibiotics should fall.

The stakes extend well beyond Nigerian farm gates. At the 2024 United Nations General Assembly high-level meeting on antimicrobial resistance, world leaders committed to reducing human deaths from drug-resistant infections by 10 percent by 2030, a goal that depends heavily on curbing antibiotic overuse in animal agriculture. Nigeria’s Federal Ministry of Livestock Development, working with the Food and Agriculture Organization, has already developed national biosecurity guidelines for poultry and aquaculture farmers, and Lagos and Ogun states have been beneficiaries of related training, which may partly explain the relatively positive knowledge scores in this study. But the researchers warn that without policy changes and sustained antimicrobial stewardship programs, meeting the WHO target that Access-group antibiotics account for the majority of national consumption will be difficult, especially in Africa. Integrated farms like those surveyed here represent a genuine opportunity for sustainable food production, the study concludes, but only if the invisible plumbing of resistance that connects chicken waste, pond water, and the human food chain is acknowledged and managed before it becomes a public health emergency.

Subject of Research: Antimicrobial use and biosecurity in integrated commercial fish-chicken farming in Southwest Nigeria

Article Title: Cross-sectional study of antimicrobial use on integrated commercial fish-chicken farming in Southwest Nigeria: the link with on-farm biosecurity, farmers’ knowledge, and attitudes

Article References: Adebowale, O., Oyawole, O., Sanni, I., Odunfa, O., Oladejo, O. O., Folorunsho, E. O., Ajibola, A. B., & Nelson, G. U. (2025). Cross-sectional study of antimicrobial use on integrated commercial fish-chicken farming in Southwest Nigeria: the link with on-farm biosecurity, farmers’ knowledge, and attitudes. BMC Agriculture, 1(1), Article 10. https://doi.org/10.1186/s44399-025-00012-y

Image Credits: AI Generated

DOI: 10.1186/s44399-025-00012-y

Keywords: antimicrobial resistance, antimicrobial use, integrated fish-chicken farming, biosecurity, aquaculture, poultry, Nigeria, WHO AWaRE classification, colistin, antimicrobial stewardship, One Health, food safety

The scale of the problem is striking. Globally, studies consistently estimate that 30 to 40 percent of pediatric antibiotic use is unnecessary, much of it driven by the treatment of viral upper respiratory tract infections that derive no benefit from antibacterial drugs. In Oman, a national multicenter audit found that 37 percent of pediatric antimicrobial prescriptions were inappropriate, with a disproportionate reliance on broad-spectrum agents such as third-generation cephalosporins. These agents, which include combinations like amoxicillin–clavulanate and later-generation cephalosporins, act against a wide range of bacteria, and their overuse accelerates the selection of resistant organisms while exposing children to avoidable adverse effects and higher costs.

Why do frontline settings struggle so much with appropriate prescribing? The review points to a convergence of pressures that clinicians in emergency and primary care know intimately. Diagnostic uncertainty is particularly acute in infants and young children, who often present with non-specific symptoms that make it difficult to distinguish a self-limiting viral illness from a bacterial infection requiring treatment. Limited access to point-of-care diagnostics compounds the problem, pushing clinicians toward empirical prescribing as a safety measure. Parental expectations add another layer: parents who believe antibiotics will speed their child’s recovery frequently request them, and time-pressed clinicians may comply. In Oman specifically, the authors note additional structural challenges, including variable prescribing autonomy across facilities, limited local antibiogram data in community settings, and inconsistent training in stewardship principles.

The stakes of getting this right extend far beyond individual prescriptions. Primary care clinics and emergency departments together account for approximately two-thirds of all antibiotic prescriptions for children worldwide, making them the central arena in which resistant pathogens are either contained or allowed to circulate. Without consistent stewardship across both community and emergency sectors, the review warns, resistant bacteria move freely between hospitals and outpatient environments, undermining public health gains achieved in any single setting. This interconnectedness means that a stewardship program confined to a tertiary hospital, however successful, cannot protect a population if prescribing practices in the clinics and emergency rooms that feed into it remain unchecked.

International guidance offers a clear framework. The American Academy of Pediatrics and the World Health Organization emphasize prescribing antibiotics only when bacterial infection is strongly suspected, favoring narrow-spectrum agents such as amoxicillin over broad-spectrum alternatives, providing safety-net or delayed prescriptions for mild self-limiting infections like otitis media, adopting short-course therapy of five to seven days for uncomplicated bacterial infections, and engaging families in shared decision-making about watchful waiting. Crucially, the evidence suggests these conservative approaches carry little clinical penalty: short courses and delayed prescriptions do not increase treatment failure rates, yet they can reduce overall antibiotic use by 25 to 30 percent. The WHO’s AWaRe classification, which sorts antibiotics into Access, Watch, and Reserve categories, provides a practical tool for monitoring whether prescribing patterns shift toward narrower agents.

The review catalogs a suite of interventions with demonstrated effectiveness. Continuous professional education combined with audit-and-feedback cycles has been shown to reduce inappropriate prescribing by 20 to 30 percent, though the authors caution that sustained behavior change requires institutional support and leadership engagement rather than one-off training events. Clinical decision support tools embedded in electronic medical records can deliver real-time alerts, weight-based dose calculators, and culture review prompts, offering scalability at the cost of potential alert fatigue and high implementation expenses. Rapid antigen detection tests for streptococcal pharyngitis, influenza, and respiratory syncytial virus help clinicians rule out bacterial causes at the point of care, reducing empirical antibiotic use, though they require investment and training. Local antibiograms—summaries of which pathogens resist which drugs—allow empiric therapy to be tailored to actual resistance patterns, but in Oman these remain more available in hospitals than in community and emergency settings. Multidisciplinary collaboration involving pharmacists, microbiologists, nurses, and infection control specialists rounds out the toolkit, fostering a stewardship culture that bridges inpatient and outpatient care.

Oman’s own experience provides some of the most encouraging data in the review. The Royal Hospital’s antimicrobial stewardship program achieved a dramatic reduction in multidrug-resistant organisms, falling from 2.8 to 0.6 per 1,000 patient-days, while generating annual cost savings estimated at 70,000 to 80,000 US dollars. These results, drawn from a national multicenter initiative, demonstrate that stewardship in the region is not merely aspirational but deliverable with measurable clinical and financial returns. The challenge now, the authors argue, is extending these gains beyond hospital walls into the pediatric emergency departments and primary care clinics where most prescribing actually occurs—and where, notably, no published data yet exists on stewardship outcomes specific to pediatric emergency care in Oman.

The policy scaffolding for such an extension already exists. Oman’s National AMR Action Plan for 2017 to 2022 rests on five pillars: public awareness and education, surveillance and research, rational antimicrobial use, infection prevention and control, and sustainable governance and coordination. These align closely with Oman Vision 2040, the country’s national development blueprint, which prioritizes health system resilience and digital transformation. Yet the review identifies persistent obstacles, including workforce shortages, inconsistent antimicrobial formularies across regions, and limited integration of stewardship data into electronic medical records. Although Oman is classified as a high-income country by the World Bank, the authors observe that some of its healthcare challenges resemble those of upper-middle-income settings, particularly regarding workforce capacity and digital infrastructure—a reminder that income classification alone does not guarantee implementation readiness.

Public behavior emerges as a critical frontier in its own right. In many communities, leftover antibiotics are stored at home, shared among family members, or taken without prescriptions, while parental perceptions that antibiotics accelerate recovery drive demand in clinics and emergency departments. The review highlights educational initiatives that have proven effective at correcting these misconceptions, including school-based programs, pharmacist-led counseling, and national media campaigns. Looking forward, the authors see promise in emerging digital technologies: artificial intelligence-driven clinical decision support, mobile applications, and e-prescription surveillance systems could transform pediatric stewardship, while expanding pharmacists’ roles to include stewardship counseling in outpatient and emergency settings represents an underutilized but impactful strategy. Community engagement through educational posters, digital waiting-room displays, and interactive family tools can reinforce responsible use between clinical encounters.

The review’s ultimate message is one of pragmatic optimism. The evidence base for reducing unnecessary pediatric antibiotic use is mature, the interventions are known, and Oman has already demonstrated that stewardship programs can deliver dramatic reductions in resistance alongside real cost savings. What remains is the harder work of systems integration: embedding evidence-based strategies into the daily workflows of busy emergency departments and primary care clinics, equipping clinicians with diagnostics and decision support, training the workforce in pediatric-specific protocols, and engaging families as partners rather than obstacles. If Oman succeeds in aligning its national AMR policies, Vision 2040 goals, and global best practices across these frontline settings, the authors conclude, it can serve as a regional exemplar for context-sensitive stewardship—and offer a template for the many health systems worldwide grappling with the same quiet crisis in their own waiting rooms.

Subject of Research: Antibiotic stewardship practices in pediatric emergency and primary care settings in Oman

Article Title: Antibiotic stewardship in pediatric emergency and primary care: a narrative review from Oman’s perspective

Article References: Antibiotic stewardship in pediatric emergency and primary care: a narrative review from Oman’s perspective. (n.d.). https://doi.org/10.1007/s44467-025-00006-5

Image Credits: AI Generated

DOI: 10.1007/s44467-025-00006-5

Keywords: antimicrobial stewardship, antimicrobial resistance, pediatrics, emergency medicine, primary care, Oman, antibiotic prescribing, clinical decision support, WHO AWaRe classification, delayed prescriptions, point-of-care diagnostics, public health