A scoping review of antimicrobial resistance surveillance and its use in guiding empirical therapy and antimicrobial stewardship in Tanzania

Antimicrobial resistance (AMR) is an increasing public health challenge in Tanzania, threatening effective antibiotic therapy and complicating management of bacterial infections. Although national and sentinel surveillance systems generate important resistance data, evidence on translation of surveillance findings into empirical therapy and routine clinical decision-making remains limited. This scoping review aimed to map AMR surveillance evidence in Tanzania, characterize reported resistance patterns among priority bacterial pathogens, and identify gaps and opportunities for integrating surveillance data into antimicrobial stewardship (AMS) and empirical antibiotic prescribing. A scoping review was conducted following Joanna Briggs Institute (JBI) methodology and reported it according to PRISMA-ScR guidelines. Literature published between January 2017 and December 2025 was searched in PubMed, PubMed Central, African Journals Online, Google Scholar, grey literature sources, and Tanzanian government repositories. Data were extracted on AMR surveillance systems, pathogen distribution, resistance profiles, multidrug resistance (MDR), extended-spectrum β-lactamase (ESBL) production, methicillin-resistant Staphylococcus aureus (MRSA), AMS activities, antibiogram availability, and use of surveillance findings in clinical practice. Thirty-two studies and policy documents were included. Tanzania has established an AMR surveillance framework supported by approximately 10 sentinel healthcare facilities across different geographical zones and levels of care; however, laboratory capacity, reporting completeness, and clinical utilization of surveillance outputs remain variable. Individual studies and surveillance reports demonstrated substantial resistance among priority pathogens. Escherichia coli showed high reported resistance to ampicillin (up to 95.8%), ceftriaxone (approximately 60%), and ciprofloxacin (approximately 69%), while Klebsiella pneumoniae demonstrated high ceftriaxone resistance (approximately 73%) and ESBL production estimates of approximately 40%. MRSA prevalence (~ 29%) and MDR estimates (40–57%) were reported mainly from hospital-based studies. AMS evidence highlighted persistent gaps, including limited availability of facility-specific antibiograms and inconsistent use of microbiological results to guide empirical therapy. Tanzania has established an important AMR surveillance foundation; however, gaps remain in laboratory capacity, antibiogram development and utilization, AMS implementation, and integration of surveillance data into clinical decision-support systems. Strengthening surveillance-to-action pathways is essential to improve evidence-informed prescribing and support implementation of the National Action Plan on AMR (2023–2028).