_1766033687 20251218045447000 Rovedar Daryoushbabazadeh@gmail.com Rovedar Journal of Veterinary Physiology and Pathology J. Vet. Physiol. Pathol. 2821-0328 12 09 2025 4 4 Mohamed Elamine Benyamina https://orcid.org/0009-0001-9760-6003 Antimicrobial resistance (AMR) is an important public health problem worldwide in humans and animals. Colistin is extensively used in veterinary medicine to control and treat enteric infections in poultry and swine, emphasizing the need to consider a One Health approach when dealing with colistin resistance. The present study aimed to provide a concise overview of the global antimicrobial resistance burden and the critical status of colistin within the World Health Organization (WHO) and European Medicines Agency (EMA) frameworks. The WHO classifies colistin in its Access, Watch, and Reserve (AWaRe) class reserve group, and the EMA restricts its use in veterinary medicine, categorizing colistin as restricted (Category B). The discovery of plasmid-mediated colistin-resistance (mcr-1) genes and their worldwide transmission to humans, animals, food, and the environment in 2015 increased urgent concerns about the continued use of colistin. The present study analyzed 44 open-access articles published between 2015 and 2025, sourced from PubMed, Scopus, and WHO/EMA databases. It investigated resistance to colistin in Escherichia coli, the spread and control of mcr genes, particularly in Africa and North America. Colistimethate sodium is for human use, and colistin sulfate is more commonly used in veterinary medicine. Over 10 variants of the mcr-1 gene have been detected in humans, animals, food, and environmental samples. In North Africa, mcr-positive isolates have been identified in both poultry and humans, reflecting the interconnected risks. The findings illustrated a persistent gap between global policies and local practice, driven by limited alternatives, weak diagnostic capacity, and uneven regulatory enforcement. As a result, colistin continues to be used despite the increasing risks of resistance. A practical One Health approach is essential to preserve this critical antibiotic. This approach should strengthen diagnostic tools, improve surveillance systems, provide training for farmers and veterinarians, and harmonize global policies with local needs, aligning with WHO AWaRe and EMA guidelines. 12 10 2025 53 57 https://creativecommons.org/licenses/by/4.0 10.58803/jvpp.v4i4.67 https://jvpp.rovedar.com/index.php/JVPP/article/view/67 https://jvpp.rovedar.com/index.php/JVPP/article/download/67/94 https://jvpp.rovedar.com/index.php/JVPP/article/download/67/94 10.1016/S0140-6736(21)02724-0 10.1186/s12941-025-00799-3 World health organization (WHO). Antibiotics portal: AWaRe groups page. World Health Organization, 2025. Available at: https://aware.essentialmeds.org/groups 10.2471/BLT.22.288614 10.1016/j.ejps.2023.106473 10.3390/antibiotics13100958 10.3390/pathogens11060659 10.7554/eLife.65836 10.3390/microorganisms12040772 10.1136/bmjopen-2023-071649 10.3389/fcimb.2025.1613414 10.3389/fvets.2021.698135 10.3390/antibiotics12030437 10.1038/s41598-025-94947-6 10.1186/s12879-024-09759-2 10.1016/S1473-3099(15)00424-7 European medicines agency (EMA). Categorisation of antibiotics in the European Union. Committee for Medicinal Products for Veterinary Use (CVMP), and Committee for Medicinal Products for Human Use (CHMP). Amsterdam: European Medicines Agency; 2019. Available at: https://ema.europa.eu/en/documents/report/categorisation-antibiotics-european-union-answer-request-european-commission-updating-scientific_en.pdf 10.1038/s41467-018-03205-z 10.3390/microorganisms12122461 10.1016/j.dcit.2023.100007 10.1080/1040841X.2018.1492902 10.3390/antibiotics14050506 10.3390/ijms26188899 10.1128/msystems.00105-22 10.1128/spectrum.02306-22 10.1016/j.jgar.2024.12.002 10.1128/AAC.01117-16 Halfaoui Z, Rahab H, Achek R, and Menoueri MN. First report of detection of mcr-1 and virulence genes in avian pathogenic Escherichia coli in the center of Algeria. Iran J Vet Res. 2024; 25(1): 5-15. DOI: 10.22099/IJVR.2024.47413.6840 10.3390/ani13081409 10.1371/journal.pone.0297921 World health organization (WHO). Global antimicrobial resistance and use surveillance system (GLASS) report 2022. Geneva: World Health Organization; 2022. Available at: https://who.int/publications/i/item/9789240062702 10.1080/22221751.2022.2030196 10.1002/hsr2.71077 10.3390/microorganisms12091920 10.3389/fvets.2022.876513 10.3389/frhs.2024.1289394 10.3390/antibiotics12081313 10.1371/journal.pgph.0003688 10.1080/20008686.2021.1962781 10.3389/fvets.2023.1153048 European Union (EU). Regulation (EU) 2019/6 of the European Parliament and of the Council of 11 December 2018 on veterinary medicinal products and repealing directive 2001/82/EC. Eur-Lex, European Union. 2019; L4: 43-167. Available at: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32019R0006 World health organization (WHO). One health joint plan of action (2022-2026). Working together for the health of humans, animals, plants, and the environment. Rome: World Health Organization; 2022. Available at: https://who.int/publications/i/item/9789240059139 10.7196/SAMJ.9644 World health organization (WHO). Implementing the global action plan on antimicrobial resistance: First quadripartite biennial report. Geneva: World health organization, food and agriculture organization of the United nations, United nations environment Programme and world organisation for animal health; 2024. Available at: https://who.int/publications/i/item/9789240074668