This study addresses the limited information on use of antimicrobials and other chemical use in commercial tilapia farms in Bangladesh. A retrospective cross-sectional survey was conducted in November 2022 in the Mymensingh district, a major tilapia production hub.

The use of both antimicrobial and non-antimicrobial medicine varied significantly by location, being significantly less likely observed in Tarakanda (p < 0.05) and Fulbaria (p < 0.01), suggesting location-specific differences in disease management. The presence of clinical signs was significantly associated with increased use of both antimicrobials, non-antimicrobial medicine and use of overall aquamedicine (p < 0.001), while longer cultivation durations showed a weak association with reduced AMU. Imprudent use of antimicrobials and other chemicals may pose One Health risks, including disruption of pond microbial ecosystems, AMR development, chemical residues, and occupational hazards. In-depth qualitative studies are needed to further understand and optimize antimicrobial and other chemical use practices and determine how tilapia farmers may benefit from improved biosecurity, training, and veterinary access.