Reflecting on Fleming’s caveat: the impact of stakeholder decision-making on antimicrobial resistance evolution

Antimicrobial resistance is a significant global health, environmental, and food security threat. Evolutionary approaches focus on proximate issues, but overlook the influence of policy and stakeholder decision-making on resistance evolution. The study examines historical case studies of beta-lactams, the largest group of antibiotics, to relate stakeholder decision-making to resistance evolution. The findings suggest sustainable approaches to curb resistance evolution, incorporating an evolutionary theory of antimicrobial resistance into decision-making within antimicrobial development, production, and stewardship.