Community-based interventions for management of antimicrobial resistance in Europe: a systematic review

Antimicrobial resistance (AMR) is a growing global health problem. Several public interventions have been designed to increase AMR knowledge and awareness. This review assesses the availability and effectiveness of community-based AMR interventions in Europe. Four databases-Medline (OVID), Pubmed, Scopus, Web of Science- and grey literature were searched for AMR interventions in community settings in Europe between 2000 and 2024. Studies reporting empirical findings in English were considered. A narrative synthesis was performed, and findings were presented in text and tables. Forty-nine studies were eligible for inclusion from 14 European countries. Interventions were primarily educational to raise awareness, targeting individuals, small groups, or the general public through mass campaigns, school-based programmes, online games, and pledges. Some interventions also monitored adherence, consumption, and doctor consultation. The majority of interventions reported increased knowledge and awareness of antibiotics and AMR; reduced antibiotic prescription, purchase, use, and non-compliance; reduced respiratory incidence and doctor consultations, and increased overall adherence. Fluctuations in knowledge over time were observed, but evidence was insufficient to analyse the long-term sustainability of outcomes of the interventions. Our findings show that community-based interventions can enhance knowledge and awareness of appropriate antibiotic use and AMR risks among different population groups. These can also positively improve adherence, expectation, and prescribing. However, long-term engagement and interventions are needed to attain sustainability and bring behavioural changes.