Antibiotic Use and Resistance in Human and Veterinary Medicine: A National Overview from Serbia

This thesis work investigates the use of antimicrobials and the prevalence of antimicrobial resistance (AMR) in the Republic of Serbia, with implications for public, animal, and environmental health. Data collected from a comprehensive literature review and national reports indicate a significantly high level of antimicrobial consumption in both human and veterinary medicine. In healthcare settings, such as hospitals, a broad spectrum of antibiotics is frequently prescribed, often without adequate microbiological pre-testing diagnostics. Self-medication and over-the-counter access to antibiotic medicines remain a significant concern, especially in most rural and underserved areas. In agriculture and veterinary medicine, antimicrobials are used both for therapeutic and prophylactic purposes, sometimes for growth promotion, which, despite regulatory efforts, keeps increasing. Antimicrobial residues have been detected in a wide range of environmental samples, including surface water and soil used in agriculture, posing ecological and long-term health risks. Surveillance data show increasing resistance rates among human pathogens such as Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus, with multidrug-resistant strains becoming more common in clinical environments. Similarly, antibiotic-resistant bacteria are being detected in livestock, raising alerts about the potential for inter-species transmission. This thesis evaluates the implementation of Serbia’s National Action Plan on AMR, finding gaps in enforcement, intersectional coordination, as well as public awareness. While Serbia works hard to align with EU antimicrobial resistance strategies, challenges persist in surveillance infrastructure, antibiotic administration, and education. Public surveys show limited awareness of AMR potential risk, giving rise to unsafe practices such as antibiotic hoarding and pressure on healthcare system providers to write prescriptions. Veterinary professionals also report inconsistent guidance and limited access to diagnostics. The findings underscore the urgent need for a One Health approach to AMR in Serbia, bringing together the healthcare system, veterinary services, agriculture, environmental agencies, and civil society. Only by enhancing public education, strengthening regulations, and enforcing data sharing and monitoring are essential steps toward mitigating the AMR threat.