Antibiotic Use and Misuse in Maritime Settings: Challenges and Implications for Global Antimicrobial Resistance Response

Abstract Purpose of Review This review aims to discuss antibiotic use and misuse in maritime settings, highlighting the unique challenges these environments pose for healthcare delivery and the implications for global antimicrobial resistance (AMR). It emphasizes the need for targeted interventions, including antibiotic stewardship programs tailored to the maritime sector. Recent Findings The maritime sector operates in geographically isolated, resource-limited environments that complicate healthcare delivery. Emerging evidence reveals that antibiotics are often misused aboard ships due to overprescription, self-medication, incomplete courses, and reliance on broad-spectrum antibiotics. Limited diagnostic tools and medical oversight further exacerbate these practices, making inappropriate antibiotic use common. Furthermore, research highlights the global connectivity of maritime trade as a significant driver of AMR dissemination, with resistant pathogens originating aboard ships spreading rapidly through international shipping routes. Emerging interventions, such as telemedicine and portable diagnostic tools, show promise in improving prescribing practices. However, limited research exists on antibiotic use in maritime settings, and the sector lacks standardized guidelines and comprehensive antimicrobial stewardship programs, leaving substantial gaps in managing antibiotic use effectively. Summary Antibiotic misuse in maritime settings is a critical but underexplored contributor to the global AMR challenge. Addressing this issue requires collaborative efforts between maritime stakeholders, public health authorities, and policymakers. Proposed strategies include enhancing training for seafarers, integrating telemedicine, implementing portable diagnostic tools, raising awareness on responsible antibiotic use, and establishing international stewardship guidelines. By prioritizing these interventions, the maritime industry can mitigate its role in AMR spread and align with global public health objectives. Major investment in research is needed to understand the transmission pathways of resistant pathogens and evaluate the effectiveness of tailored stewardship initiatives in these unique settings.