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The article describes Kerala, India, and outlines its state-wide AMR mitigation approach, centered on the Kerala Antimicrobial Resistance Strategic Action Plan (KARSAP). It highlights policymakers’ leadership, participatory antimicrobial stewardship via district/block committees, and One Health multisector coordination. The work reviews KARSAP objectives, strategic priorities, and time-bound targets across KARSAP 1.0, including development of surveillance and diagnostic capacity.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/when-policy-makers-have-your-back-the-kerala-experience-with-state-wide-antimicrobial-resistance-mitigation-efforts/139728/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/when-policy-makers-have-your-back-the-kerala-experience-with-state-wide-antimicrobial-resistance-mitigation-efforts/139728.png","ImageObject",300,407,{"name":92,"@type":93},"Ivy","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-21","2026-08-24",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What factors contribute to antimicrobial resistance discussed in the article?","Question",{"text":112,"@type":113},"AMR is linked to misuse of antimicrobials, inadequate infection prevention and control, poor-quality medicines, weak laboratory capacity, insufficient surveillance, and limited regulation of antimicrobial drugs.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What is KARSAP and what is its role in Kerala’s AMR response?",{"text":117,"@type":113},"KARSAP is Kerala’s sub-national AMR strategic action plan conceptualized and implemented on a One Health platform, drafted jointly by health and multiple related departments to build surveillance, multisector strategies, periodic review, and prevention/management integration.",{"name":119,"@type":110,"acceptedAnswer":120},"How does the article describe policymakers’ involvement and participatory antimicrobial stewardship in Kerala?",{"text":121,"@type":113},"Kerala’s program emphasizes that policymakers treat AMR as a crisis, provide leadership, and support technical experts. Participatory antimicrobial stewardship is implemented through district and block-level AMR committees and public participation to ensure a whole-of-society approach.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},139728,1787561523,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":143},549758252649,"https://ap-avatar.wpscdn.com/avatar/8000253669c5317157?_k=1778319167496531819","Antimicrobial Stewardship & Healthcare Epidemiology (2025), 5, e152, 1–6 doi:10.1017/ash.2025.10060  \nCommentary  \nWhen policy-makers have your back: the Kerala experience with state-wide antimicrobial resistance mitigation efforts  \nAravind Reghukumar MD1 , Rajalakshmi Ananthanarayanan DNB, FRCP, FIDSA, FSHEA2 , K.V. Nandakumar MBBS3, P.S. Sivaprasad DCH4, S. Manjusree MD5, R. Jyothi MD5, Heera Hassan MD5 , Ajan Maheswaran Jaya MD6  ,  \nH. Sreenadh MD7  and R. Nikhilesh Menon MD8  \n1Department of Infectious Diseases, Government Medical College, Thiruvananthapuram, Kerala, India, 2Infectious Diseases, KIMSHEALTH, Trivandrum, Kerala, India, 3Additional Director of Health Services [Medical], State Program Officer, AMR Health Services, Government of Kerala, Trivandrum, Kerala, India, 4National Health Mission, Government of Kerala, Trivandrum, Kerala, India, 5Department of Microbiology, Government Medical College, Thiruvananthapuram, Kerala, India, 6Health Services-Medical and Hospital Administration, Government of Kerala, Thiruvananthapuram, Kerala, India, 7Department of Health Services, Family Health Centre Noolpuzha, Wayanad, Kerala, India and 8Department of Health Services, One Health and AARDRAM mission, Government of Kerala, Thiruvananthapuram, Kerala, India  \nBackground  \nAntimicrobial resistance (AMR) has been recognized as one of the biggest public health challenges by the World Health Organisation (WHO) . On September 21, 2016, the United Nations (UN) General Assembly met to discuss AMR.1 Although AMR is a natural phenomenon, it is propagated by misuse of antimicrobial medicines, inadequate or nonexistent programs for infection prevention and control (IPC), poor-quality medicines, weak laboratory capacity, inadequate surveillance, and insufficient regulation of antimicrobial drugs. As AMR threatens the very core of modern medicine, in May 2015, the World Health Assembly adopted a global action plan on AMR.2,3 During the 79th UN General Assembly meeting on AMR, held on September 26 2024, global leaders approved a political declaration related to AMR. These included committing to a clear set of targets and actions, like reducing the estimated 4.95 million human deaths associated with bacterial AMR annually by 10% by 2030 .4 The declaration calls for sustainable national financing and USD100 million in catalytic funding to support funded national action plans on AMR. The declaration also sets an ambitious target that at least 70% of antibiotics used for human health globally should belong to the WHO Access group, 100% of countries having basic water, sanitation, hygiene, and waste management services in all health care facilities, and 90% of countries meeting WHO’s minimum requirements for IPC program by 2030 . AMR mitigation efforts require a whole-of-society approach with strong political will and commitment to ensure that all stakeholders work in unison and implement local, context-specific solutions. It is in this context that AMR mitigation efforts taken by Kerala, a state in South India known for its high literacy rate, are discussed here. The AMR program in Kerala is called the Kerala Antimicrobial Resistance  \nCorresponding author: Rajalakshmi Ananthanarayanan; Email: dr.a.rajalakshmi@ [gmail.com](gmail.com)  \nCite this article: Reghukumar A, Ananthanarayanan R, Nandakumar KV, et al. When policy-makers have your back: the Kerala experience with state-wide antimicrobial resistance mitigation efforts. Antimicrob Steward Healthc Epidemiol 2025. doi: 10.1017/ ash.2025.10060  \nStrategic Action Plan (KARSAP) .5 The highlight of the program is the policymakers of the state considering AMR as a crisis, taking the lead, and supporting the technical experts for the execution. Another unique aspect is the measures taken for AMR mitigation, which is based on participatory antimicrobial stewardship (AMS), whereby, through district and block-level AMR committees and public participation, a whole-of-society approach is ensured. Go","cbCaiqH0YPsy9g5k","https://ap.wps.com/l/cbCaiqH0YPsy9g5k","pdf",420478,"English","# Background\n## Global and national AMR policy context\n# Kerala’s state-wide AMR mitigation approach\n## KARSAP and One Health coordination\n## Objectives and strategic priorities\n## Monitoring, evaluation, and time-bound targets","[{\"question\":\"What factors contribute to antimicrobial resistance discussed in the article?\",\"answer\":\"AMR is linked to misuse of antimicrobials, inadequate infection prevention and control, poor-quality medicines, weak laboratory capacity, insufficient surveillance, and limited regulation of antimicrobial drugs.\"},{\"question\":\"What is KARSAP and what is its role in Kerala’s AMR response?\",\"answer\":\"KARSAP is Kerala’s sub-national AMR strategic action plan conceptualized and implemented on a One Health platform, drafted jointly by health and multiple related departments to build surveillance, multisector strategies, periodic review, and prevention/management integration.\"},{\"question\":\"How does the article describe policymakers’ involvement and participatory antimicrobial stewardship in Kerala?\",\"answer\":\"Kerala’s program emphasizes that policymakers treat AMR as a crisis, provide leadership, and support technical experts. Participatory antimicrobial stewardship is implemented through district and block-level AMR committees and public participation to ensure a whole-of-society approach.\"}]","When policy-makers have your back - the Kerala experience with state-wide antimicrobial resistance mitigation efforts | PDF",15]