Abstract Background Antibiotic resistance (ABR) is a growing global health concern, with inappropriate prescribing practises playing a significant role. The drug resistance index (DRI) is a composite metric used by policymakers to assess the effectiveness of antibiotic therapy, where a score of 0 indicates complete susceptibility and 100 indicating complete resistance. Methods This study evaluated the DRI for Escherichia coli and Klebsiella pneumoniae using antibiotic consumption and resistance data from two public sector hospitals in the uMgungundlovu District in KwaZulu-Natal, between 2017 and 2019. Antibiotic consumption (ABC) data were sourced from the Provincial Department of Health for one district and one tertiary hospital, while antibiotic resistance data were obtained from a surveillance study of urinary tract and bloodstream infections. ABC was calculated using the WHO GLASS methodology, incorporating Defined Daily Dose (DDD) and bed-occupancy. Results The DRI ranged from 55-58 for E. coli and and 68-88 for K. pneumoniae, across the study period, indicating reduced effectiveness of current empiric treatments . Conclusion These findings highlight the urgent need to revise standard treatment guidelines at the hospital level. Strengthening national surveillance of ABR and ABC is essential to inform evidence-based policy and optimize antimicrobial stewardship. Disclosures Sabiha Essack, B. Pharm, M. Pharm, PhD, CARB-X: Board Member|GSK: Honoraria|Reckitt (Pty.) Ltd.: Honoraria
Essack et al. (2026) studied this question.