Antimicrobial resistance, antibiotic prescribing practices and antimicrobial stewardship in South Africa: a scoping review

Abstract

Introduction: Antimicrobial resistance (AMR) is an emerging global threat, with notable impact evident in low- and middle-income countries. Indiscriminate antibiotic prescribing is recognized as the key factor responsible for the continued spread of AMR. Objectives: To comprehensively map published data of evidence of AMR in healthcare settings in South Africa, encompassing the exploration of antibiotic prescribing practices and the implementation of antimicrobial stewardship initiatives. Methods: The scoping review methodology was based on the guidelines outlined by Arksey and O’Malley. The protocol for this scoping review has been registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/PWMFB). The search strategy was documented using the protocol outlined within the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). Databases used were Science Direct, Scopus, PubMed, Wiley, Directory of Open Access Journals; and health organizations such as the WHO. In addition, the Google search engine was used to search for grey matter. The search was restricted to peer-reviewed articles in English on human studies for the period 2019–24. Results: The search yielded a total of 529 articles from electronic databases and search engines. Twenty-nine articles were accepted for inclusion following the application of the study protocol. The majority of the articles were primary research papers. Conclusions: The findings reveal that South Africa has measures in place to combat AMR; however, inconsistencies were found between the private and public health sectors, in addition to the lack of adherence to guidelines and limitations in AMR education among healthcare workers and students.