The international community sits at the tipping pointof a post-­‐antibiotic era, where common bacterial infections are no longer treatable with the antibiotic armamentarium that exists. In South Africa, t...he identification of the first case of pan-­‐resistant Klebsiella pneumoniae(Brink et al, J Clin Microbiol. 2013;51(1):369-­‐72) marks a watershed moment and highlights ourtip of the antibiotic resistance ‘iceberg’ in this country. Multi-­‐drug resistant (MDR)-­‐bacterial infections, predominantly in Gram-­‐negative bacteria such as Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosaand Acinetobacter baumanniiare now commonplace in South African hospitals. Whilst a number of expensive new antibiotics for Gram-­‐positive bacterial infections have been manufactured recently (some of which are licenced for usein South Africa), no new antibiotics active against Gram-­‐negative infections are expected in the next 10-­‐15years. Hence what we have now, needs conserving more

S Afr Med J 2018;108(7):546-550. DOI:10.7196/SAMJ.2018.v108i7.13149 Antimicrobial stewardship programmes have been introduced worldwide in response to the rise in antimicrobial resistance. The World Health Organization has mandated each Member State to produce a plan to address this problem. We rep...ort on the organic development of an antibiotic stewardship programme in a rural regional hospital in a resource-limited setting in South Africa. This has resulted in organisational change with increased awareness, participation, monitoring and education in antibiotic stewardship throughout the hospital more

Antimicrobial resistance (AMR) as a serious public health threat was globally acknowledged by WHO in 2015, through the launch of the Global Action Plan (GAP). With a limited number of new antibiotics in the developmental pipeline, many countries are in the process of establishing strategies for anti...microbial stewardship (AMS). Within each country, different healthcare challenges have contributed to AMR. This has also shaped individual AMS strategies and policies. In South Africa (SA), there is a high burden of infectious diseases, mainly of bacterial origin. In addition, SA also has the highest number of people living with human immunodeficiency virus (HIV) globally. According to the 2019 statistics, there are approximately 7.97 million people living with HIV in SA. Together with this, SA has the fourth largest tuberculosis population globally. Other important challenges include poverty, malnutrition, a high burden of non-communicable diseases, and a dire shortage of trained healthcare professionals (e.g. clinicians, pharmacists, and nurses). more