Introduction: Antimicrobial resistance (AMR) is among the top three health threats worldwide. It requires an effective response by implementing proper antimicrobial stewardship (AMS) measures. In Hungary, AMR is also a considerable problem, with overuse and misuse of antimicrobials. Despite still being one of the highest in Europe, Hungarian veterinary antibiotic consumption has significantly improved over the past decade. In contrast, however, the quantity of antibiotics used in human health care is relatively low, measured as DDD per 1000 inhabitants per day, but utilization and resistance patterns show worsening tendencies. In this study, we wanted to explore the quality of the current Hungarian AMS systems in human and animal health care and the barriers and facilitators of their operations.

Methods: We conducted a qualitative study using in-depth interviews with twelve Hungarian stakeholders representing the human, animal, and environmental sectors at ministerial, regulatory authority, and hospital/university levels. Semi-structured interviews were transcribed and analyzed using NVivo 15.

Results and discussion: Key informants revealed that the Hungarian veterinary antibiotic policy is greatly driven by the legal obligations of the EU Common Agricultural Policy, with its strong financial protection system focusing on food-producing animals. All sectorial interviewees emphasized that their national veterinary heath sector is aware of the problem of AMR and actively take all measures to achieve their goals. The identified facilitators were good intrasectorial communication and cooperation, ambitious leadership, efficient law-making, high-level education of vets, and the existence of antibiotic reduction strategies. In human health care, almost only pull-back factors were reported by the participants about the weak sectorial antibiotic policy, such as institutional (no dedicated leadership at any levels, no institutional framework, and lack of proper data collection and monitoring), juridical (no implemented national action plan, no legal background,and lack of funding), and personal factors (clinicians’ resistance to change and the general population’s low health literacy).