Part VII: Interventions Principal authors: A Visser, D P Moore, A Whitelaw, W Lowman, G Kantor

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.