Cited by 95Antibiotic Use and ResistancePharmacy and Medical PracticesAntibiotic Resistance in Bacteria

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

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Sono, Tiyani Milta, Yeika, Eugene, Cook, Aislinn, Kalungia, Aubrey, Opanga, Sylvia A., Acolatse, Joseph Elikem Efui, Sefah, Israel Abebrese, Jelić, Ana Golić, Campbell, Stephen, Lorenzetti, Giulia, Ul Mustafa, Zia, Marković-Peković, Vanda, Kurdi, Amanj, Anand Paramadhas, Bene D, Rwegerera, Godfrey Mutashambara, Amu, Adefolarin A, Alabi, Mobolaji Eniola, Wesangula, Evelyn, Oluka, Margaret, Khuluza, Felix, Chikowe, Ibrahim, Fadare, Joseph O., Ogunleye, Olayinka O., Kibuule, Dan, Hango, Ester, Schellack, Natalie, Ramdas, Nishana, Massele, Amos, Mudenda, Steward, Hoxha, Iris, Moore, Catrin E., Godman, Brian, Meyer, Johanna C.·2023·Expert Review of Anti-infective Therapy

DOI 10.1080/14787210.2023.2259106

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Abstract

INTRODUCTION: 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. AREAS COVERED: 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 antibiotics without a prescription). However, considerable variation was seen 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. EXPERT OPINION: 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 healthcare professionals, should enhance appropriate dispensing of antibiotics and reduce AMR.

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Knowledge and Practice of Pharmacists toward Antimicrobial Stewardship in Pakistan
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Authors: Sono, T. M., Yeika, E., Cook, A., Kalungia, A., Opanga, S. A., Acolatse, J. E. E., Sefah, I. A., Jelić, A. G., Campbell, S., Lorenzetti, G., Ul Mustafa, Z., Marković-Peković, V., Kurdi, A., Anand Paramadhas, B. D., Rwegerera, G. M., Amu, A. A., Alabi, M. E., Wesangula, E., Oluka, M., Khuluza, F., Chikowe, I., Fadare, J. O., Ogunleye, O. O., Kibuule, D., Hango, E., Schellack, N., Ramdas, N., Massele, A., Mudenda, S., Hoxha, I., Moore, C. E., Godman, B., & Meyer, J. C.
Affiliations: Sefako Makgatho Health Sciences University (ZA)
Ministry of Public Health (CM)
St George's, University of London (GB)
University of Zambia (ZM)
University of Nairobi (KE)
Cape Coast Teaching Hospital (GH)
University of Health and Allied Sciences (GH)
Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia & Herzegovina
Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
Hawler Medical University (IQ)
Department of Health Services Management, Central Medical Stores, Ministry of Health, Gaborone, Botswana
University of Botswana (BW)
Pharmacy Department, Eswatini Medical Christian University, Mbabane, Kingdom of Eswatini
University of KwaZulu-Natal (ZA)
East, Central and Southern Africa Health Community (TZ)
Kamuzu University of Health Sciences (MW)
Ekiti State University (NG)
Lagos State University (NG)
Busitema University (UG)
University of Namibia (NA)
University of Pretoria (ZA)
Hubert Kairuki Memorial University (TZ)
University of Medicine Tirana (AL)
University of Strathclyde (GB)
Corresponding author: Godman, Brian
ORCID: Yeika, Eugene
Cook, Aislinn
Kalungia, Aubrey
Acolatse, Joseph Elikem Efui
Sefah, Israel Abebrese
Jelić, Ana Golić
Campbell, Stephen
Lorenzetti, Giulia
Ul Mustafa, Zia
Marković-Peković, Vanda
Kurdi, Amanj
Anand Paramadhas, Bene D
Rwegerera, Godfrey Mutashambara
Alabi, Mobolaji Eniola
Wesangula, Evelyn
Oluka, Margaret
Khuluza, Felix
Chikowe, Ibrahim
Fadare, Joseph O.
Ogunleye, Olayinka O.
Kibuule, Dan
Hango, Ester
Schellack, Natalie
Ramdas, Nishana
Massele, Amos
Mudenda, Steward
Moore, Catrin E.
Godman, Brian
Meyer, Johanna C.
Venue: Expert Review of Anti-infective Therapy
Publisher: Informa UK Limited
Published: 2023-10-03
Volume: 21
Issue: 10
Pages: 1025-1055
ISSN: 1478-7210 (ISSN-L)
1744-8336
DOI: 10.1080/14787210.2023.2259106
OpenAlex: W4386979632
Cited by: 95
References: 223
Citations by year: 2026: 20 · 2025: 44 · 2024: 24 · 2023: 7
FWCI: 1.84
Type: journal article
Language: en
Open access: green
figshare.com
Licence: cc-by
Locations: Expert Review of Anti-infective Therapy (publishedVersion)
PubMed (publishedVersion)
St George's Online Research Archive (St George's University of London) (acceptedVersion)
Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (acceptedVersion)
Figshare (submittedVersion, cc-by)
Research Explorer (The University of Manchester) (submittedVersion)
UpSpace Institutional Repository (University of Pretoria) (submittedVersion)
Figshare (cc-by)
Funders: Medical Research Council (MC_PC_16090)
Topics: Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
Health Sciences › Health Professions › Pharmacy › Pharmacy and Medical Practices
Health Sciences › Medicine › Microbiology (medical) › Antibiotic Resistance in Bacteria
Keywords: antibiotic self-medication, antimicrobial resistance, antimicrobial stewardship programs, community pharmacy, sub-Saharan Africa, pharmacy education, patient education, copayments, inappropriate antibiotic use
MeSH terms: Anti-Bacterial Agents, Ethiopia, Humans, Pharmacists, Drug Prescriptions

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

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