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Background Antimicrobial resistance constitutes a major public health issue that leads to poor outcomes and increased costs associated with healthcare. Solid organ transplant recipients are more prone due to prolonged exposure to antimicrobials. Methods We reviewed existing programs in the Kingdom of Saudi Arabia and pattern of drug resistance, and the extent of transplant medicine in the kingdom through published articles in databases and official documents from health authorities. Results A national committee for antimicrobial resistance (AMR) was established to set the guidelines required for an antimicrobial stewardship program (ASP), especially when there is a high prevalence of AMR. A survey noted that ASPs are implemented in only 26% of Saudi Ministry of Health hospitals. Factors affecting the implementation of ASPs in Saudi hospitals included a lack of necessary staff resources and specific ASP staff/teams to advocate adopting ASP in the organizations. Specific attention should be given to transplant patients as transplantations are expected to increase in the next few years. No antimicrobial stewardship programs are currently specifically tailored to transplant centers. Conclusion The current healthcare system transformation in Saudi Arabia should take into consideration the urgent need for effective ASP that might help face the increasing trends in the multidrug-resistant organisms (MDRO) prevalence rate.

_eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1111/tid.13891