Antibiotic consumption in 14 countries of sub-Saharan Africa: Findings from a retrospective analysis

This multi-country study analysed antimicrobial consumption (AMC) in 327 hospital and community pharmacies across 14 African countries using retrospective data from 2016–2019. National-level data were available for 11 countries, showing an overall AMC of 8.42 DID, though with very large variation between countries. Most countries (82%) and most pharmacies (72%) met the WHO AWaRe target of ≥60% Access-category antibiotic use, but antibiotic consumption relied on a very narrow range of drugs, reflecting limited diversity in available treatment options. National essential medicines lists included only 70% of WHO-recommended Access antibiotics and very few Reserve agents, while many non-WHO-recommended drugs were circulating. The findings highlight that low and poorly diversified antibiotic availability limits effective treatment and that expanding equitable access to appropriate antimicrobials must go hand in hand with stewardship. Strengthening systems to generate high-quality AMU, AMC and AMR data should be a priority in national AMR action plans and broader health system development.