The largest reservoir for these bacteria is the gut of humans and animals. Antibiotics, even those administered parenterally usually achieve significant levels in the large bowel, resulting in a strong selective pressure. The growth of propensity particularly in for instance India and China in the last 20 years has driven large increases in the use of antibiotics in these countries. Agriculture in these and similar countries is rapidly industrialising resulting in greater antibiotic use. In these areas we have seen the enzymes of CTX-M15 and 14 and the mix of faecal carriage rates in the normal population to >50%. This has resulted in greater use of carbapenems in human medicine with rapidly emerging resistance (e.g. KPC, ND19, IMP & OXA-48) and with heavy use of Colistin in China in agriculture plasmid medicated high level resistance (Mcr-1). The release of human sewage even after treatment has been shown to only reduce discharge of AMR genes poorly. Veterinary antibiotics again reach the environment from their use in agriculture and via manure with high faecal carriage rates in the gut of intensively produce food animals. Food consumption theme completes the cycle increasing carriage in commensal opportunistic pathogens for humans such as E.coli and Klebsiella ssp. “A one health approach” is needed on a global scale which together with case studies will be discussed.