Editorial: Innovations and impacts of antimicrobial stewardship in primary care and proximity settings

Innovative antimicrobial stewardship (AMS) approaches are needed to mitigate its impact, expanding into diverse community healthcare settings. This includes primary care settings and proximity, where most human and animal antimicrobial exposure occurs. Individualized, community-based approaches to stewardship, extending beyond conventional prescribing in hospital-settings, are recognized. This includes public engagement, education on self-care, inclusion of veterinary sectors and broader societal determinants of AMR. Technological advancements and policy implementations highlight the continuous evolution of stewardship measures, underscoring the need for ongoing research, interdisciplinary collaboration, and adaptive frameworks to address emerging challenges.The goal of this Research Topic is to explore the latest innovations and impacts of antimicrobial stewardship in primary care and proximity settings, and identify barriers to stewardship in these settings. The papers in this collection provide valuable insights into the evolving landscape of AMS across different target populations and This was facilitated by rapid diagnostic self-testing, guided self-treatment, selfmonitoring and supported self-management. Importantly, digital health technologies and community health systems emerge as key enablers of responsible self-care.However, the authors caution that self-care is not risk-free and benefits may be While the first three contributions focus on strengthening stewardship interventions, Amábile-Cuevas presents an important and thought-provoking challenge to conventional AMS assumptions. The author argues that the relationship between antibiotic consumption and resistance is more complex than traditionally acknowledged. Socioeconomic, environmental, and biological factors may influence resistance patterns as strongly as, or more than clinical antibiotic use. This perspective does not dismiss the value of stewardship but rather encourages a reassessment of its objectives. Stewardship programs undoubtedly improve patient safety, reduce unnecessary antimicrobial exposure, and lower healthcare costs.However, expecting AMS alone to reverse resistance trends may be unrealistic considering broader drivers such as agricultural antimicrobial use, urbanization, sanitation challenges, and the dissemination of mobile genetic elements. This argument reinforces the need for stewardship efforts to be embedded within wider health systems and incorporate societal approaches.Taken together, the contributions in this collection highlight several recurring themes.First, AMS is increasingly moving beyond hospitals into communities, households, pharmacies, and agricultural settings. Second, effective stewardship requires engagement of multiple stakeholders, including patients, caregivers, pharmacists, veterinarians, policymakers, and public health practitioners. Third, education remains a cornerstone of stewardship, whether directed at self-carers, parents, healthcare professionals, or livestock keepers. Finally, the complexity of AMR demands that stewardship strategies evolve from narrowly focused prescribing interventions toward integrated approaches that address behavioral, environmental, regulatory, and socioeconomic determinants.The future of AMS in primary care and proximity settings depends on our ability to balance innovation with evidence-based implementation. Self-care technologies, digital health tools, public awareness campaigns, and One Health interventions offer promising opportunities to improve antimicrobial use. Simultaneously, stewardship programs must remain cognizant of their limitations and continuously adapting to the multifactorial nature of AMR. This collection demonstrate that meaningful progress is achievable when stewardship is viewed not merely as a clinical intervention, but as a shared societal responsibility.As AMR continues to threaten global health gains, these contributions reaffirm that effective stewardship must be collaborative, context-specific, and inclusive. By bringing AMS closer to the communities, primary care and proximity settings are poised to become critical frontiers in the global response to AMR.