Abstract:
Antibiotic stewardship of hospital-acquired infections because of difficult-to-treat resistant
(DTR) Gram-negative bacteria is a global challenge. Their increasing prevalence in South
Africa has required a shift in prescribing in recent years towards colistin, an antibiotic of
last resort. High toxicity levels and developing resistance to colistin are narrowing treatment
options further. Recently, two new β-lactam/β-lactamase inhibitor combinations,
ceftazidime-avibactam and ceftolozane-tazobactam were registered in South Africa,
bringing hope of new options for management of these life-threatening infections. However,
with increased use in the private sector, increasing levels of resistance to ceftazidimeavibactam
are already being witnessed, putting their long-term viability as treatment
options of last resort, in jeopardy. This review focuses on how these two vital new antibiotics
should be stewarded within a framework that recognises the resistance mechanisms
currently predominant in South Africa’s multi-drug and DTR Gram-negative bacteria.
Moreover, the withholding of their use for resistant infections that can be treated with
currently available antibiotics is a critical part of stewardship, if these antibiotics are to be
conserved in the long term.
