Scoping literature review of antimicrobial dispensing practices among patent medicine vendors in Sub-Saharan Africa

Despite regulatory frameworks in many Sub-Saharan African (SSA) countries prohibiting the sale of prescription medications by patent medicine vendors (PMVs), over-the-counter dispensing of antimicrobial agents remains widespread. Over time, resistance rates to commonly prescribed antibiotics have increased. This review synthesises existing published literature on antimicrobial dispensing practices among PMVs in SSA, examining types, appropriateness, and gender-related patterns to inform strategies for addressing antimicrobial resistance in the region. An electronic search of PubMed, Zendy, and Google Scholar databases was performed for studies on dispensing practices of patent medicine vendors in SSA, conducted between January 2014 and December 2024. Findings were systematically reviewed to identify patterns, coded, and categorised into recurring themes. A total of 14 studies were included; 12 were cross-sectional, 2 were a combination of prospective and cross-sectional studies. There were high levels of non-prescription antimicrobial sales, with most PMVs dispensing incomplete doses and failing to require prescriptions. Types of antimicrobials mostly dispensed include amoxicillin, ciprofloxacin, azithromycin, and artemisinin-based combination therapy (ACT). The commonest indications for antimicrobials were fever, abdominal problem, respiratory infections, and diarrhoea. Abdominal pain was more common among females, while respiratory symptoms were more prevalent in children. Reported drivers of antimicrobial dispensing among PMVs include consumer demand, lack of PMV training, profit motives, and self-medication. Improper supply of antimicrobials, driven by high consumer demand, inadequate training, and financial incentives, poses considerable risks, including treatment failures and antimicrobial resistance. To ensure safer and more rational antimicrobial use, strengthening regulatory enforcement and implementing targeted training programs for PMVs should be prioritised as essential strategies for promoting appropriate dispensing practices and improving public health outcomes.