Insights into antimicrobial resistance (AMR) and antimicrobial stewardship (AMS) in the management of respiratory diseases in the USA are given in a report from FIP today. A FIP insight board gathered at the FIP congress in September 2023 discussed respiratory infection management post COVID-19, pharmacist-led AMS programmes, diagnostic services, patient and healthcare professional education and the One Health approach in the US context. Unique challenges related to point-of-care testing, collaboration with other healthcare professionals and reimbursement of services, and ideas for fostering collaboration with different sectors are presented in the report.