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Scientists have known for more than half a century that patients could develop resistance to the drugs used to treat them. Alexander Fleming, who is credited with creating the first antibiotic, penicillin, in 1928, cautioned of the impending crisis while accepting his Nobel prize in 1945: “There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” Since then antibiotics have proved one of the most effective interventions in human medicine. Sadly, the overuse and misuse of this precious resource have brought us to a global crisis of antimicrobial resistance (AMR). To address this crisis nearly seven decades after Fleming’s lecture the first UN general assembly meeting on drug resistance bacteria was convened in September 2017. It is only the fourth time the general assembly has held a high-level meeting for a health issue. The UN secretary general, Ban Ki-moon, said antimicrobial resistance is a “fundamental threat” to global health and safety. He went on to say “If we fail to address this problem quickly and comprehensively, antimicrobial resistance will make providing high-quality universal healthcare coverage more difficult if not impossible. It will undermine sustainable food production and put the sustainable development goals in jeopardy.” Just before world leaders convened for the meeting, all 193 member states agreed in a declaration to combat the proliferation of antibiotic resistance. The need for the solution to AMR requiring a “One Health” approach is well accepted. The importance of reducing overuse and misuse of antibiotics by promoting prudent use is one fundamental component of this solution – the concept of antimicrobial stewardship. In the human population, ensuring prudent prescribing across different communities and settings, in different patient populations, in diverse geographies, resources and cultures requires a truly innovative, flexible, collaborative and cross-disciplinary approach. As a global community only by innovating and adapting and adopting the resources we have available to us can we effect true transformational change in prescribing practice.