Antimicrobial Use and Resistance; An Overview in Human and Veterinary Medicine in Kazakhstan.

Antimicrobial resistance (AMR) is a global health threat according to the World Health Organization (WHO). The misuse of antibiotics creates selective pressure which results in survival and multiplication of resistant bacteria, and spread of resistance genes. This thesis aims to describe antibiotic use in human and veterinary medicine and antimicrobial resistance (AMR) in Kazakhstan. Antibiotic (AB) consumption and over-the-counter (OTC) antibiotic sales have increased in Kazakhstan during the COVID-19 pandemic, due to the ban of inspection of small businesses, including pharmacies. Azithromycin and ceftriaxone were the most consumed ABs in 2021 and 2023. The over-the-counter AB sales and imprudent antibiotic consumption may have contributed to increase the burden of AMR in Kazakhstan. Recently, in Kazakhstan the use of ABs, including drugs such as cephalosporins and fluoroquinolones which are commonly used in human medicine, increased in companion animals . As a consequence, the risk of transmission of resistant genes and bacteria between animals is also increasing. Effective national AMR surveillance systems can support both human and veterinary clinicians, guide healthcare policymakers, aiming at controlling the spread of AMR within the country. Kazakhstan has a government-approved National Action Plan (NAP) that is currently being implemented. However, coverage and regional representation of AMR data need improvement, since data collection and reporting, along with its coordination and management, varies vastly between different regions in the country. In addition, Kazakhstan must increase the adoption of External Quality Assessment (EQA) standards within the laboratory facilities to ensure the collection of reliable and trustworthy data on AMR. To preserve the antimicrobials effectiveness and prevent the spread of resistant genes in the environment, pets, and humans, it is extremely important to utilize ABs rationally in veterinary and human medicine.