Current rates of purchasing of antibiotics without a prescription across sub-Saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance

Tiyani Milta Sono, Eugene Yeika, Aislinn Cook, Aubrey Kalungia, Sylvia A. Opanga, Joseph Elikem Efui Acolatse, Israel Abebrese Sefah, Ana Golić Jelić, Stephen Campbell, Giulia Lorenzetti, Zia Ul Mustafa, Vanda Marković-Peković, Amanj Kurdi, Bene D Anand Paramadhas, Godfrey Mutashambara Rwegerera, Adefolarin A Amu, Mobolaji Eniola Alabi, Evelyn Wesangula, Margaret Oluka, Felix Khuluza, Ibrahim Chikowe, Joseph O. Fadare, Olayinka O. Ogunleye, Dan Kibuule, Ester Hango, Natalie Schellack, Nishana Ramdas, Amos Massele, Steward Mudenda, Iris Hoxha, Catrin E. Moore, Brian Godman, Johanna C. Meyer

Antimicrobial resistance (AMR) is a global concern. Currently, the greatest mortality due to AMR is in Africa. A key driver continues to be high levels of dispensing of antibiotics without a prescription. A need to document current rates of dispensing, their rationale and potential ways forward including antimicrobial stewardship programmes (ASPs). A narrative review was undertaken. The highest rates of antibiotic purchasing were in Eritrea (up to 89.2% of antibiotics dispensed), Ethiopia (up to 87.9%), Nigeria (up to 86.5%), Tanzania (up to 92.3%) and Zambia (up to 100% of pharmacies dispensing without a prescription). However, considerable variation with no dispensing in a minority of countries and situations. Key drivers of self-purchasing included high co-payment levels for physician consultations and antibiotic costs, travel costs, convenience of pharmacies, patient requests, limited knowledge of antibiotics and AMR and weak enforcement. ASPs have been introduced in some African countries along with quality targets to reduce inappropriate dispensing, centering on educating pharmacists and patients. ASP activities need accelerating among community pharmacies alongside quality targets, with greater monitoring of pharmacists' activities to reduce inappropriate dispensing. Such activities, alongside educating patients and HCPs, should enhance appropriate dispensing of antibiotics and reduce AMR.