Decades of injudicious antibiotic prescribing and a disregard for basic infection control practice have left the international community facing a return to the age of untreatable bacterial infections. The rise of extended spectrum beta-lactamase (ESBL)-producing bacteria and subsequently carbapenemase-resistant strains has left colistin as the sole antibiotic in the armamentarium for these infections, an antibiotic from the 1960s with a high toxicity profile. Colistin resistance has already been reported, rendering some patients untreatable. The recent identification and subsequent spread of New Delhi Metallo-beta-lactamase-1 (NDM-1) and Klebsiella pneumonia carbapenemase (kpc)-producing Enterobacteriaceae signify the latest ‘super-bugs’ to threaten public health. The number of NDM-1 infections in Gauteng is rising rapidly with spread to other South African cities. South Africa needs a strong, coordinated, and urgent response to this threat. Clinical governance of antibiotic prescribing (antibiotic stewardship) through dedicated programmes and infection control practice must be strengthened if we are to control the situation.

The South African Antibiotic Stewardship Programme will:

1. Provide leadership, advocacy for, and strengthening of, antibiotic stewardship in the public and private sectors in South Africa.
2. Direct appropriate training in antibiotic stewardship and coordinate dissemination of antibiotic stewardship information to all sectors of South Africa’s health care system and civil society.
3. Engage with the Health Professions Council of South Africa to propose that antibiotic stewardship CPD becomes mandatory, as is the case for ethics.
4. Harmonize existing national antibiotic prescribing guidelines and develop guidelines for those infections not already covered, for adult and paediatric practice, incorporating principles of antibiotic stewardship and optimal diagnostic testing into one document.
5. Identify gaps in current knowledge and the necessary operational research/audit that will inform practice. Feedback the results of these studies to stakeholders, so as to implement change.
6. Engage with the National Department of Health and industry to address the economic issues and systemic obstacles surrounding antibiotic costs and stewardship.
7. Make recommendations for high quality, evidence-based antimicrobial stewardship interventions including the structure and organisation of stewardship programmes and promotion of core high-impact interventions in different settings.

Accepting that public and private sector healthcare presents different health structures and challenges, the working group resolved to engage the following key stakeholders:

• In the private sector, a point person will be identified in each private health care group, who in turn will nominate a point person for contact in each private hospital or clinic.
• In the public sector, key stakeholders identified as provincial DOH, CEOs of Hospitals and Deans of University departments of Health Science will be engaged with. Provincial working groups representing all these stakeholders, such as that already formed in KwaZulu Natal, will liaise with the SAASP working group to effect change.
• The co-chairs of SAASP working group will approach the National Department of Health (DOH) to invite a representative to be part of the SAASP Working Group. This will give insight to the working group and facilitate engagement with NDOH in presenting a proposed national framework policy for antibiotic stewardship.