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

Aim: This systematic review examined the practices and challenges of implementing antimicrobial stewardship (AMS) in sub-Sahara Africa (SSA) regulated retail medicine settings. Methods: We searched studies published between January 1, 2010, and July 30, 2024, from PubMed, Web of Science, ProQuest Central, Google Scholar, African Journals Online, and Wiley Online Library. We also reviewed reference lists of studies included in the review. The included studies were quality-assessed using the Mixed Method Appraisal Tool, with data analysed thematically. The protocol was registered in the International Prospective Register for Systematic Reviews (PROSPERO), registration number CRD42023381320. Results: Of the 2,555 screened studies, 26 met the inclusion criteria; eight qualitative, 16 quantitative and two mixed methods . Community pharmacists, accredited drug dispensers, and patent medicine vendors were reported to be aware of antimicrobial resistance (AMR) and AMS. Across studies with extractable numeric data (n = 10), the median prevalence of non-prescription antibiotic dispensing was 67.5% (IQR: 52.5–84.9%), indicating that the practice is widespread in sub-Saharan Africa. However, few studies documented AMS activities that have taken place. Reported barriers to AMS included non-prescription antibiotic dispensing, weak regulation, and economic pressures despite knowledge of antibiotics, antibiotic resistance and the importance of AMS. Conclusion: Our study revealed limited data on AMS implementation in SSA-regulated retail medicine settings. Despite self-reported awareness of AMR, AMS efforts are hindered by systemic challenges such as economic constraints, weak regulatory enforcement, and systemic barriers. Strengthening regulations, public awareness, and multi-stakeholder collaboration is critical to improving AMS in SSA retail medicine settings.