Antimicrobial resistance (AMR) surveillance activities in South
Africa have been described in Part V of this report. Surveillance –
knowing the levels of resistance and the trends around the country
and in different types of institutions – is essential, but is only useful
to the extent that the data influence practice. That link is not made
automatically, nor is it always easy. Choices must be made among
the available interventions based on what will work best in a given
situation, and taking into consideration feasibility, cost, likely
impact, acceptability to patients and providers, political will, etc.
Clearly, surveillance and recent studies can inform revisions of
the essential drugs list (EDL) and standard treatment guidelines
(STGs). What is more difficult but still possible is that these data
can influence and change antibiotic prescribing practices and result
in policy formulation geared to limit inappropriate antibiotic use
and, consequently, AMR and its spread. However, so far the efficacy
and clinical outcomes of both EDLs and STGs have, since their
implementation, not been adequately evaluated.
Reducing the burden of infectious diseases also reduces the need
for antibiotics but, primarily, prevents illness. Vaccination and
infection prevention and control in hospitals and other health care
facilities are the two critical interventions in this category.
In this section, the status and challenges of all these interventions
in South Africa are reviewed.