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ABSTRACT Background Antimicrobial resistance (AMR) presents a significant global mortality burden which particularly affects the low‐ and middle‐income countries (LMICs). Enhancing diagnostics to identify drug‐resistant infections and improving appropriate access to novel Reserve antibiotics in LMICs can address AMR‐related morbidity, mortality and healthcare costs. This article characterizes the AMR landscape across 14 LMICs and describes an introductory pathway for novel Reserve antibiotics. Methods This mixed‐method study was completed in 14 LMICs in Africa, the Americas, Asia and Europe through a combination of qualitative interviews with physicians and public health experts (PHEs), and a quantitative survey of physicians, supported by an assessment of secondary materials relating to antibiotic introduction and AMR burden. Results A total of 54 physicians and 17 PHEs were interviewed, and 209 physicians participated in the survey. Top unmet needs across public and private settings were as follows: access to new antibiotics to better manage drug‐resistant infections; affordability; adequate safety profile for prescribed antibiotics. Access to diagnostics and antibiotic susceptibility testing was noted as a barrier, with large tertiary and private centres experiencing better access. Implementation of antibiotic stewardship programmes was variable and limited by insufficient funding, shortage of infectious disease physicians, poor AMR education and lack of restrictions to limit antibiotic use. Antibiotic access varies by sector, centre type, location and strength of individual state procurement systems. In particular, private sector facilities have better access to Reserve products. In most countries, most Reserve antibiotics included in WHO's Essential Medicines List (EML) were not included in national EMLs or not registered in countries. Conclusion This study has helped to identify common barriers and pathways to Reserve antibiotic access, irrespective of the level of preparedness of countries. The data offer insights into possible solutions to improve access and highlight opportunities to strengthen access pathways and expedite access, for example, by identifying priority antibiotics based on national public health need. A six‐step introductory pathway for novel Reserve antibiotics is described.

Background: Antimicrobial resistance (AMR) is a growing public health threat in Africa. AMR prevention and control requires coordination across multiple sectors of government and civil society partners. Objectives: To assess the current role, needs, and capacities of CSOs working in AMR in Africa. Methods: We conducted an online survey of 35 CSOs working in 37 countries across Africa. The survey asked about priorities for AMR, current AMR-specific activities, monitoring practices, training needs, and preferences for sharing information on AMR. Further data were gathered on the main roles of the organisations, the length of time engaged in and budget spent on AMR-related activities, and their involvement in the development and implementation of National Action Plans (NAPs). Results were assessed against The Africa Centres for Disease Control and Prevention (Africa CDC) Framework for Antimicrobial Resistance (2018–2023). Results: CSOs with AMR-related activities are working in all four areas of Africa CDC’s Framework: improving surveillance, delaying emergence, limiting transmission, and mitigating harm from infections caused by AMR microorganisms. Engagement with the four objectives is mainly through advocacy, followed by accountability and service delivery. There were limited monitoring activities reported by CSOs, with only seven (20%) providing an example metric used to monitor their activities related to AMR, and 27 (80%) CSOs reporting having no AMR-related strategy. Half the CSOs reported engaging with the development and implementation of NAPs; however, only three CSOs are aligning their work with these national strategies. Conclusion: CSOs across Africa are supporting AMR prevention and control, however, there is potential for more engagement. Africa CDC and other government agencies should support the training of CSOs in strategies to control AMR. Tailored training programmes can build knowledge of AMR, capacity for monitoring processes, and facilitate further identification of CSOs’ contribution to the AMR Framework and alignment with NAPs and regional strategies.