The Global Governance of Antibiotic Stewardship: A One Health Scoping Review and the Integrated Polycentric Glocal Governance Framework (IPGF)

Abstract

Antimicrobial resistance (AMR) poses a serious and growing threat to global public health, undermining decades of progress in infectious disease control. Antibiotic stewardship (ABS) — aimed at optimizing antimicrobial use across human, animal, and environmental health — has become central to this response. This article presents a scoping review of 203 academic and grey literature sources to examine the global governance architecture of ABS. Anchored in a One Health lens and drawing on multi-level and polycentric governance theory, the review maps key actors, institutional arrangements, and policy mechanisms shaping international stewardship efforts. Despite growing consensus, stewardship governance remains fragmented, underfunded, and marked by stark disparities between high-income and low- and middle-income countries. To address these challenges, the paper proposes an original Integrated Polycentric Glocal Governance Framework (IPGF) and applies it to two case studies in the Middle East and North Africa (MENA) region. This model emphasizes decentralized coordination, stakeholder inclusivity, and adaptive learning to better align global norms with local realities. The findings call for structural reform and innovative governance approaches to strengthen global antibiotic stewardship and mitigate the accelerating AMR crisis