Abstract：
The emergent threat of antimicrobial resistance (AMR) has resulted in debates around the use and preservation of effective antimicrobials. Concerns around AMR reflect a history of increasing dependence on antibiotics to address disease epidemics rooted in profound structural and systemic challenges. In the context of global health, this process, often referred to as pharmaceuticalisation, has commonly occurred within disease programmes, of which lessons are vital for adding nuance to conversations around antimicrobial stewardship. Tuberculosis (TB) is a notable example. A disease which accounts for one-third of AMR globally and remains the leading cause of death from a single infectious agent in many low - and middle-income countries, including South Africa. In this scoping review, we chart TB science in South Africa over 70 years of programming. We reviewed published manuscripts about the programme and critically reflected on the implications of our findings for stewardship. We identified cycles of programmatic responses to new drug availability and the emergence of drug resistance, which intersected with cycles of pharmaceuticalisation. These cycles reflect the political, economic, and social factors influencing programmatic decision-making. Our analysis offers a starting point for research exploring these cycles and drawing out implications for stewardship across the TB and AMR communities.
摘要：
抗菌素耐药性（AMR）的新兴威胁引发了关于有效抗菌素使用和保存的争论。对AMR的担忧反映了对抗生素日益依赖的历史，以解决根植于深刻的结构性和系统性挑战的疾病流行。在全球卫生的背景下，这个过程,通常被称为制药，通常发生在疾病计划中，其中的教训对于增加围绕抗菌药物管理的对话的细微差别至关重要。结核病（TB）是一个显著的例子。这种疾病占全球AMR的三分之一，在许多低收入和中等收入国家仍然是单一传染因子死亡的主要原因，包括南非。在这次范围审查中，我们绘制了南非70多年的结核病科学。我们审查了有关该计划的已发表手稿，并批判性地反映了我们的发现对管理的影响。我们确定了对新药可用性和耐药性出现的方案反应周期，与制药周期相交。这些周期反映了政治，经济,和影响方案决策的社会因素。我们的分析为探索这些周期的研究提供了起点，并为结核病和AMR社区的管理提供了启示。
