Demand for animal protein is rising globally and has been facilitated by the expansion of intensive farming. However, intensive animal production relies on the regular use of antimicrobials to maintain health and productivity on farms. The routine use of antimicrobials fuels the development of antimicrobial resistance, a growing threat for the health of humans and animals. Monitoring global trends in antimicrobial use is essential to track progress associated with antimicrobial stewardship efforts across regions. We collected antimicrobial sales data for chicken, cattle, and pig systems in 41 countries in 2017 and projected global antimicrobial consumption from 2017 to 2030. We used multivariate regression models and estimated global antimicrobial sales in 2017 at 93,309 tonnes (95% CI: 64,443, 149,886). Globally, sales are expected to rise by 11.5% in 2030 to 104,079 tonnes (95% CI: 69,062, 172,711). All continents are expected to increase their antimicrobial use. Our results show lower global antimicrobial sales in 2030 compared to previous estimates, owing to recent reports of decrease in antimicrobial use, in particular in China, the world’s largest consumer. Countries exporting a large proportion of their production are more likely to report their antimicrobial sales data than countries with small export markets.

ntimicrobials are used in agriculture as disease treatments, prophylactically to prevent infections in healthy animals and to increase productivity 1 . However, the routine use of antimicrobials as surrogates for good hygiene practices on farms 2,3 is driving a rise in antimicrobial resistance (AMR), with increasingly serious consequences for animal health 1,4 and potentially for human health 5,6 .Globally, 73% of antimicrobials are used in animals 7 , with China being the largest consumer of antimicrobials in absolute terms (41,967 t in 2017) and the second largest consumer in relative terms with 200 mg kg −1 (ref. 8 ) (Supplementary Fig. 1a,b). In comparison, Denmark and the Netherlands use respectively 39 and 56 mg kg −1 (ref. 9 ), while maintaining a productive livestock sector. Multiple factors may contribute to antimicrobial overuse in China. Meat production has grown by 560% since 1979 (FAOSTAT, http://www. fao.org/faostat/en/#data/QL), which could have made farmers reliant on antimicrobials to prevent infections. Veterinary antimicrobials are reportedly accessible without prescriptions 10 and are sold at low prices in comparison to other countries 11 . As in many other low-and middle-income countries (LMICs) 12,13 , farmers predominantly obtain antimicrobials from local drug stores where vendors also provide medical advice without veterinary training 10,14 . Additionally, enforcing the existing regulations 10 on the compounds authorized in animals, or the recently announced ban on growth promoters 15 , remains a formidable challenge in a country where 360 million people are active in agriculture (World Bank, https:// data.worldbank.org/indicator/SL.AGR.EMPL.ZS). In the last 5 yr, China has reported multiple first emergence of resistance genes to last-resort antimicrobials such as colistin and tigecycline 16,17 and a recent global analysis suggested that China may have become one of the largest hotspots of resistance among LMICs 4 , ranking eighth in relative terms, and first in absolute terms, for the animal-associated burden of AMR amongst LMICs (Supplementary Fig. 1d,e).

Background and Objective: Childcare attendance is a common risk factor for acute respiratory illness (ARI) in young children. Our goal was to better understand the specific respiratory viruses that predominate in childcare, which may support the development of tailored illness prevention and intervention strategies in childcare settings. Methods: Using data from a prospective household cohort of ARI surveillance, we assessed specimen from 1418 ARIs reported by 359 childcare-aged children over 6 study seasons (2012/2013 through 2017/2018). Respiratory swabs were tested by polymerase chain reaction for 9 respiratory viruses. A mixed-effect logistic regression model was used to compare odds of various viral detection outcomes. The Shannon’s Diversity index was used to compare the richness (ie, number of species) and diversity (ie, relative species abundance) associated with respiratory viruses detected in both groups. Results: At least 1 virus was detected in 75.5% of childcare-associated ARIs and in 80.1% of homecare ARIs. Compared with illnesses among homecare children, childcare illnesses were associated with significantly higher odds of detected adenovirus (odds ratio = 1.86, 95% confidence interval = 1.05–3.28) and human metapneumovirus (odds ratio = 1.76, 95% confidence interval = 1.03–3.0). The pool of viruses associated with childcare ARI was found to be significantly richer and more diverse than that of viruses associated with homecare ARI (P < 0.0001). Conclusions: Children attending childcare experience a higher risk of adenovirus and human metapneumovirus infection and are regularly exposed to a rich and diverse pool of respiratory viruses in childcare environments. Our results underscore the necessity of thorough and multifaceted viral prevention strategies in childcare settings.

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