Claas KirchhellePaul AtkinsonAlex BroomKomatra ChuengsatiansupJorge Pinto FerreiraNicolas FortanéIsabel FrostChristoph GradmannStephen HinchliffeSteven J. HoffmanJavier LezaunSusan NayigaKevin OuttersonScott H. PodolskyStephanie RaymondAdam P. RobertsAndrew C. SingerAnthony D. SoLuechai SringernyuangElizabeth TaylerSusan Rogers Van KatwykClare I.R. ChandlerDahdaleh Institute for Global Health ResearchOxford Social Sciences DivisionInfectious Diseases Research CollaborationYork UniversityLondon School of Hygiene & Tropical MedicineOrganisation Mondiale de la SantéUniversity of ExeterThe University of SydneyLiverpool School of Tropical MedicineUniversity of LiverpoolBoston UniversityImperial College LondonMahidol UniversityUniversitetet i OsloUniversité Paris-DauphineJohns Hopkins Bloomberg School of Public HealthUniversity College DublinUK Centre for Ecology & HydrologyHarvard Medical SchoolInnovation + Design Enabling Access (IDEA) InitiativeAntimicrobial Resistance and Veterinary Products DepartmentCenter for Disease Dynamics, Economics and PolicyPrincess Maha Chakri Sirindhorn Anthropology Centre2020-11-182020-11-182020-09-23BMJ Global Health. Vol.5, No.9 (2020)205979082-s2.0-85092384801https://repository.li.mahidol.ac.th/handle/123456789/60082© 2020 Author(s) (or their employer(s)). Re-use permitted under CC BY. Published by BMJ. There is increasing concern globally about the enormity of the threats posed by antimicrobial resistance (AMR) to human, animal, plant and environmental health. A proliferation of international, national and institutional reports on the problems posed by AMR and the need for antibiotic stewardship have galvanised attention on the global stage. However, the AMR community increasingly laments a lack of action, often identified as an â € implementation gap'. At a policy level, the design of internationally salient solutions that are able to address AMR's interconnected biological and social (historical, political, economic and cultural) dimensions is not straightforward. This multidisciplinary paper responds by asking two basic questions: (A) Is a universal approach to AMR policy and antibiotic stewardship possible? (B) If yes, what hallmarks characterise â € good' antibiotic policy? Our multistage analysis revealed four central challenges facing current international antibiotic policy: metrics, prioritisation, implementation and inequality. In response to this diagnosis, we propose three hallmarks that can support robust international antibiotic policy. Emerging hallmarks for good antibiotic policies are: Structural, Equitable and Tracked. We describe these hallmarks and propose their consideration should aid the design and evaluation of international antibiotic policies with maximal benefit at both local and international scales.Mahidol UniversityMedicineReviewSCOPUS10.1136/bmjgh-2020-003091