Antibiotic and Antimalarial Self-Medication Among Community Pharmacy Clients in the Niger Delta: A Stewardship and Antimicrobial Resistance Perspective

Background: Self-medication with antimicrobial agents is a well-recognised driver of antimicrobial resistance (AMR), a risk that is amplified in low- and middle-income countries where regulatory oversight of prescription-only medicines remains limited. Community pharmacies, although intended to function as gatekeepers of rational medicine use, may inadvertently serve as an unsupervised supply channel for antimicrobial agents. Objective: This study sought to quantify the prevalence and pattern of antibiotic and antimalarial self-medication among community pharmacy clients in Yenagoa Local Government Area (LGA), Bayelsa State, Nigeria, and to interpret these findings within an antimicrobial stewardship framework. Methods: A cross-sectional descriptive survey was undertaken among 554 adult community pharmacy clients, recruited through stratified random sampling and assessed using a structured, interviewer-administered questionnaire. Data pertaining to self-medicated drug categories, indications, knowledge of self-medication and its consequences, and sources of information were analysed descriptively. Results: Overall, 59.0% of respondents (327/554) reported having self-medicated within the preceding six months. Antibiotics (13.5%) and antimalarials (10.1%) constituted the second- and third-most frequently self-medicated drug categories, surpassed only by sexual enhancement products (30.9%). Infection (16.5%) and malaria/fever (13.1%) were, respectively, the second- and fourth-most commonly reported indications. Notably, 82.1% of respondents correctly identified that self-medication may precipitate adverse drug reactions, drug interactions and antimicrobial resistance, while 85.4% recognised the danger of altering medication dosage without professional consultation — findings that indicate awareness of AMR-related risk without a corresponding change in behaviour. Social media (33.9%) and personal knowledge (31.5%) were the principal sources of information underpinning self-medication, with a doctor or pharmacist cited as the information source in only 17.4% of instances. Conclusion: A substantial minority of community pharmacy clients in this Niger Delta population self-medicate with antibiotics and antimalarials despite widespread awareness of AMR-related risk, suggesting that this behaviour reflects an awareness-behaviour gap rather than a knowledge deficit. These findings lend support to pharmacy-level antimicrobial stewardship interventions, dispensing-point restrictions on antibiotic sales, and the design of behavioural, rather than purely educational, interventions.