Citation: Salam, M.A.; Al-Amin, M.Y.; Salam, M.T.; Pawar, J.S.; Akhter, N.; Rabaan, A.A.; Alqumber, M.A.A. Antimicrobial Resistance: A Growing Serious Threat for Global Public Health. Healthcare 2023, 11, 1946. https://doi.org/10.3390/ healthcare11131946 Academic Editor: Atsushi Irisawa Received: 29 April 2023 Revised: 30 June 2023 Accepted: 30 June 2023 Published: 5 July 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). healthcare Review Antimicrobial Resistance: A Growing Serious Threat for Global Public Health Md. Abdus Salam 1, * , Md. Yusuf Al-Amin 2,3 , Moushumi Tabassoom Salam 4 , Jogendra Singh Pawar 5,6 , Naseem Akhter 7 , Ali A. Rabaan 8,9 and Mohammed A. A. Alqumber 10 1 Department of Basic Medical Sciences, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan 25200, Malaysia 2 Purdue University Interdisciplinary Life Sciences Graduate Program, Purdue University, West Lafayette, IN 47907, USA; amin50@purdue.edu 3 Department of Chemistry, Purdue University, West Lafayette, IN 47907, USA 4 Department of Pharmacy, University of Rajshahi, Rajshahi 6205, Bangladesh; moushumi5350@gmail.com 5 Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN 47907, USA; pawar.72@osu.edu 6 The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH 43210, USA 7 Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA; nakhter2@hfhs.org 8 Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia; arabaan@gmail.com 9 College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia 10 Laboratory Medicine Department, Faculty of Applied Medical Sciences, Albaha University, Al Baha 65431, Saudi Arabia; maali@bu.edu.sa * Correspondence: abdussalam@iium.edu.my Abstract: Antibiotics are among the most important discoveries of the 20th century, having saved millions of lives from infectious diseases. Microbes have developed acquired antimicrobial resistance (AMR) to many drugs due to high selection pressure from increasing use and misuse of antibiotics over the years. The transmission and acquisition of AMR occur primarily via a human–human inter- face both within and outside of healthcare facilities. A huge number of interdependent factors related to healthcare and agriculture govern the development of AMR through various drug-resistance mechanisms. The emergence and spread of AMR from the unrestricted use of antimicrobials in livestock feed has been a major contributing factor. The prevalence of antimicrobial-resistant bacteria has attained an incongruous level worldwide and threatens global public health as a silent pandemic, necessitating urgent intervention. Therapeutic options of infections caused by antimicrobial-resistant bacteria are limited, resulting in significant morbidity and mortality with high financial impact. The paucity in discovery and supply of new novel antimicrobials to treat life-threatening infections by resistant pathogens stands in sharp contrast to demand. Immediate interventions to contain AMR include surveillance and monitoring, minimizing over-the-counter antibiotics and antibiotics in food animals, access to quality and affordable medicines, vaccines and diagnostics, and enforcement of leg- islation. An orchestrated collaborative action within and between multiple national and international organizations is required urgently, otherwise, a postantibiotic era can be a more real possibility than an apocalyptic fantasy for the 21st century. This narrative review highlights on this basis, mechanisms and factors in microbial resistance, and key strategies to combat antimicrobial resistance. Keywords: antibiotics; antimicrobial resistance; mechanisms of resistance; drivers of resistance; measures to combat resistance 1. Introduction Antibiotics are the “magic bullets” for fighting against bacteria and are considered as the most remarkable medical discovery of the 20th century. The introduction of an- tibiotics has changed the therapeutic paradigm and continues to save millions of lives Healthcare 2023, 11, 1946. https://doi.org/10.3390/healthcare11131946 https://www.mdpi.com/journal/healthcare