Abstract:
There are concerns with the current prescribing of antibiotics in both the private and
public primary care settings in South Africa. These concerns need to be addressed going forward
to reduce rising antimicrobial resistance (AMR) rates in South Africa. Concerns include adherence
to current prescribing guidelines. Consequently, there is a need to comprehensively summarise
current antibiotic utilization patterns from published studies as well as potential activities to improve
prescribing, including indicators and antimicrobial stewardship programs (ASPs). Published studies
showed that there was an appreciable prescribing of antibiotics for patients with acute respiratory
infections, i.e., 52.9% to 78% or more across the sectors. However, this was not universal, with
appreciable adherence to prescribing guidelines in community health centres. Encouragingly, the
majority of antibiotics prescribed, albeit often inappropriately, were from the ‘Access’ group of
antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than ‘Watch’ antibiotics to
limit AMR. Inappropriate prescribing of antibiotics in primary care is not helped by concerns with
current knowledge regarding antibiotics, AMR and ASPs among prescribers and patients in primary
care. This needs to be addressed going forward. However, studies have shown it is crucial for
prescribers to use a language that patients understand when discussing key aspects to enhance
appropriate antibiotic use. Recommended activities for the future include improved education for all
groups as well as regularly monitoring prescribing against agreed-upon guidelines and indicators.
