Strengthening diagnostic stewardship for antimicrobial resistance in Africa

Abstract

Antimicrobial resistance (AMR) has emerged as one of the defining public health challenges of our time, threatening progress in modern medicine and undermining decades of gains in infectious-disease control [1]. Often described as a “silent pandemic,” AMR now inflicts the highest mortality burden globally on the African continent — eclipsing the combined toll of HIV and malaria in several regions [2,3]. Despite this immense burden, Africa’s response to AMR has largely focused on antimicrobial stewardship and surveillance, while a critical but underdeveloped pillar — diagnostic stewardship — has received far less attention [4].
Diagnostic stewardship refers to the coordinated effort to promote the appropriate use of microbiological tests to guide patient management, antimicrobial therapy, and infection-prevention decisions [5]. It is the essential bridge that allows clinicians to move away from guesswork and toward targeted, pathogen-specific antibiotic therapy, enabling the critical practice of de-escalation to narrow antibiotic coverage once a diagnosis is confirmed. In many African settings, empirical treatment remains the default approach because of limited laboratory infrastructure, delayed test results, and lack of clinician confidence in diagnostic services [6].