Community pharmacists as antimicrobial resistance stewards: a narrative review on their contributions and challenges in low- and middle-income countries
Open accessAbstract
Antimicrobial resistance (AMR) is a global public health crisis that impedes the therapeutic effectiveness of available antimicrobial agents. Due to the high burden of infectious diseases and limited resources, especially trained healthcare professionals, low- and middle-income countries (LMICs) are particularly susceptible to the detrimental effects of AMR. Sometimes, as the first and last point of contact for patients seeking treatment for infections, community pharmacists can play a pivotal role in the stewardship required for AMR. This review aims to highlight the contributions made by community pharmacists in LMICs as AMR stewards. The review considers the challenges from the perspectives of limited resources, inadequate training, a lack of policies and regulations, and issues related to patient behavior. Community pharmacists in LMICs could optimize their advocacy contributions by focusing on One Health AMR stewardship. Transformational and actionable patient and population-centric antimicrobial stewardship (AMS) is feasible with the synergy of policymakers and other healthcare providers in the implementation of AMS policies and programs that support community pharmacists in their efforts to promote rational antimicrobial use.
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This pressure often results in prioritizing profits over patient care, leading to the over-dispensing of antibiotics.
“This pressure often results in prioritizing profits over patient care, leading to the over-dispensing of antibiotics. 10”
From Evaluation of antibiotic dispensing without prescription by community pharmacies: a simulated patient study (2025) · cites this paper as [10]
The “Limited resources” section says community pharmacists in LMICs must balance patient health and profitability, and that reliance on antibiotic sales can pressure them to dispense antibiotics even when unnecessary. It does not establish that this pressure often results in pharmacists prioritizing profit over patient care; the review describes the reliance as occurring “sometimes.” (LLM, conf=0.82)
Experimental — accuracy not yet measuredMany pharmacies face pressure to maintain sales, especially due to increasing competition from online pharmacies.
“However, many pharmacies face pressure to maintain sales, especially due to the increasing competition from online pharmacies.”
From Evaluation of antibiotic dispensing without prescription by community pharmacies: a simulated patient study (2025) · cites this paper as [10]
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- Authors
- Raju, R., Srinivas, S. C., Siddalingegowda, S. M., Vaidya, R., Gharat, M., & Kumar, T. M. P.
- Affiliations
- JSS Academy of Higher Education and Research (IN)
- Corresponding author
- Siddalingegowda, Srikanth Malavalli
- Venue
- Journal of Pharmacy & Pharmaceutical Sciences
- Publisher
- Frontiers Media SA
- Published
- 2024-06-13
- Volume
- 27
- Pages
- 12721-12721
- ISSN
- 1482-1826 (ISSN-L)
- PMC
- PMC11208321
- OpenAlex
- W4399652885
- Cited by
- 25
- References
- 84
- Citations by year
- 2026: 14 · 2025: 10 · 2024: 1
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Pharmacy & Pharmaceutical Sciences (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Pfizer
- JSS Academy of Higher Education and Research
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Keywords
- antimicrobial resistance, antimicrobial stewardship, community pharmacists, low- and middle-income countries, rational antimicrobial use, One Health, pharmacy education, patient behavior, resource-limited settings
- MeSH terms
- Antimicrobial Stewardship, Community Pharmacy Services, Developing Countries, Humans, Pharmacists, Professional Role
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