Cycles of antibiotic use and emergent antimicrobial resistance in the South African tuberculosis programme (1950-2021): A scoping review and critical reflections on stewardship

Antimicrobial resistance (AMR) is a growing concern due to the increasing dependence on antibiotics to address disease epidemics. Pharmaceuticalisation, a process in global health, has often occurred within disease programs. Tuberculosis (TB) is a notable example, accounting for one-third of AMR globally and leading cause of death in low- and middle-income countries. A scoping review of TB science in South Africa over 70 years identified cycles of programmatic responses to new drug availability and drug resistance, intersecting with cycles of pharmaceuticalisation. This analysis provides a starting point for research exploring these cycles and their implications for stewardship in TB and AMR communities.