Antibiotics and Resistance in Human and Veterinary Medicine: A National Overview in Lebanon

Antimicrobial resistance (AMR) is a major public health concern worldwide, particularly in low- and middle-income countries where regulation of antibiotic use is often limited. This review examines antibiotic use and antimicrobial resistance in Lebanon across human healthcare and veterinary sectors. In human medicine, antibiotic use is dominated by penicillins, penicillin combinations, and quinolones, most commonly prescribed for respiratory tract infections. Inappropriate prescribing, widespread over-the-counter access to antibiotics, and poor adherence to prescribed treatment courses remain common practices. In hospital settings, the most frequently reported resistant bacteria are Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, indicating a substantial burden of resistant Gram-negative infections. In veterinary medicine, particularly in livestock production, penicillins, tetracyclines, and aminoglycosides are most frequently used, mainly for the treatment of mastitis and respiratory infections, often without diagnostic confirmation and using mass treatment. Overall, the findings indicate that antimicrobial resistance in Lebanon persists partly due to continued inappropriate antibiotic use in both human and veterinary medicine, despite the existence of regulatory frameworks, reflecting gaps between policy implementation and antibiotic prescribing and dispensing practices, together with limited public awareness. In this context, increased consideration of alternative, non-antibiotic approaches such as phytotherapy and bacteriophage-based therapies, alongside improved awareness of appropriate antibiotic use, may contribute to reducing reliance on conventional antibiotics and limiting further resistance development. These efforts should be supported by antimicrobial stewardship initiatives and surveillance systems to ensure coordinated and sustainable antimicrobial resistance control.