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Antimicrobial resistance (AMR).
“South Africa, and indeed the rest of the world, is facing a serious healthcare crisis: antimicrobial resistance (AMR). AMR threatens the effectiveness of essential antimicrobial medicines,” states Andriette van Jaarsveld, a Clinical Pharmacy Specialist at Mediclinic Southern Africa.
She observes, “While this might seem like a distant or abstract issue to many, consider the implications of surgeries performed without antibiotics to prevent infections or a basic Urinary Tract Infection that cannot be resolved. This could be our reality in as little as 10 years.”
In 2023, the World Health Organization reported that AMR was directly responsible for 1.27 million deaths worldwide in 2019 and contributed to a further 4.95 million deaths. In addition to the potential economic impact of AMR, with patients requiring longer and more intensive and expensive treatments, it is believed that this “silent pandemic” could surpass other causes of mortality by 2050.
Van Jaarsveld explains that AMR occurs when various microorganisms—such as bacteria, viruses, fungi, and parasites—develop resistance to antimicrobial medicines. This makes antibiotics and other drugs ineffective, posing significant challenges for infection treatment. Consequently, resistant microbes lead to higher risks of disease transmission, severe illness, disability, and death.
Incorrect usage is driving the potential threat
Since their introduction into medicine, antibiotics have played a vital role in treating infectious diseases, subject to proper dosage and clinical necessity. However, as early as the 1940s, it was recognised that irresponsible use or diagnosis would significantly impact our healthcare system.
“AMR is primarily driven by the overuse of antibiotics. In addition to incorrect prescribing by healthcare workers, patient expectations also lead to unnecessary antibiotic prescriptions. We have to understand that such medications are not always needed – and that when it is appropriate, the patient has a responsibility to take the antibiotic at the same time of day [AVJ1] and to finish the course as prescribed,” details Van Jaarsveld.
How does this impact a country like South Africa?
While AMR is present globally, low—and middle-income countries face a disproportionately larger burden. This is primarily driven by factors such as political, economic, socio-cultural, and ecological issues. With limited resources and often insufficient data, these countries will suffer the heaviest burden of communicable diseases, including the effects of AMR. Additionally, lack of access to clean water, sanitation, and overall hygiene exacerbates conditions.
According to the available data, in South Africa in 2021, there were approximately 8485 deaths directly attributed to antimicrobial resistance, and around 35,054 deaths associated with bacterial AMR. The associated deaths refer to those in which AMR played a role but was not the sole cause. In contrast, the attributable deaths are directly caused by AMR. The data for subsequent years (2022-2025) on AMR-attributable deaths are not explicitly detailed in the sources reviewed; however, the 2021 numbers highlight a significant mortality burden that likely persists or trends similarly without major intervention.
More than 5 000 deaths were associated with AMR in children under 5, with over 1 000 of those being directly attributable to AMR.
What is Mediclinic doing to limit AMR?
Mediclinic has aligned with the WHO guidelines by implementing Antimicrobial Stewardship (AMS) programs across all our hospitals. AMS is defined as a coordinated, multidisciplinary effort to optimise the use of antimicrobials, improving patient outcomes while minimising antimicrobial resistance and safeguarding patient safety. We do regular multidisciplinary rounds at our patients’ bedside to optimise antimicrobial use and have guidelines and policies in place that support the AMS programme. We also measure Antimicrobial use across our hospitals.