Community Drivers of AMR

Survey evidence in sub-Saharan Africa consistently shows high rates of non-prescription antibiotic dispensing from community drug outlets and pharmacies. Self-medication and widespread over-the-counter antibiotic availability drive inappropriate community antibiotic use where regulation and enforcement are weak. Poor water, sanitation, and hygiene infrastructure facilitates the spread of resistant organisms and resistance genes. Structural contributors to community antibiotic misuse include limited prescriber access, affordability barriers, fragmented pharmaceutical markets, and sociocultural determinants. Agricultural misuse of antibiotics in livestock and inadequate manure management create selection pressure and cross-sectoral dissemination opportunities. Community antibiotic misuse includes treatment of viral conditions, incorrect dosing, incorrect duration, and poor adherence.