A systematic review of antimicrobial stewardship practices and challenges in sub-Sahara Africa (SSA) regulated retail medicine settings

This systematic review assessed antimicrobial stewardship (AMS) practices in regulated retail medicine settings across sub-Saharan Africa and found substantial gaps between awareness and implementation. Based on 26 studies published between 2010 and mid-2024, the review shows that community pharmacists, accredited drug dispensers, and patent medicine vendors are generally aware of antimicrobial resistance (AMR) and the principles of AMS, yet non-prescription antibiotic dispensing remains highly prevalent, with a median rate of 67.5%. Very few studies reported concrete AMS interventions, and implementation is consistently undermined by weak regulatory enforcement, economic pressures, and entrenched dispensing practices despite adequate knowledge. Overall, the findings highlight a critical need for stronger regulation, improved public awareness, and coordinated multi-stakeholder action to translate AMR awareness into effective AMS practice in retail medicine settings in sub-Saharan Africa.