Understanding how community pharmacists in Nigeria steward antimicrobials: an interview study

Abstract Introduction Antimicrobial resistance (AMR) is a global public health challenge, largely driven by inappropriate antimicrobial use in community settings, resulting in significant economic costs.1 In Nigeria, community pharmacists are well-positioned to support antimicrobial stewardship (AMS) programmes but remain underutilised. Limited evidence exists on how community pharmacists balance ethical responsibilities with patient demands or strengthen stewardship within an existing regulatory system. Aim This study aimed to explore how community pharmacists in Nigeria manage antimicrobials and contribute to AMS efforts. Methods Community pharmacists who were registered with the Pharmacists Council of Nigeria (PCN), worked in community pharmacies in the Federal Capital Territory (FCT), Abuja, with a minimum of two years’ experience, were recruited via the Association of Community Pharmacists (ACPN), FCT, Abuja. A purposive sampling approach was used. Semi-structured interviews were used to explore experiences and perspectives related to community pharmacists’ use and dispensing of antimicrobials in their community pharmacy. Interviews were conducted via telephone or Microsoft Teams, depending on participant preference. All interviews were audio-recorded and transcribed verbatim. Anonymised transcripts were imported into NVivo (QSR International) for data management and coding. Data were analysed using Braun and Clarke’s reflexive thematic analysis.2 Results Eleven participants took part in the study. Participants had between 15–25 years of practice experience with six superintendent pharmacists, three pharmacist business owners and two full-time pharmacists. Interviews lasted 25–35 minutes. Four themes were generated. (1) Professional roles and stewardship responsibilities: Pharmacists positioned themselves as custodians of antimicrobial safety, describing responsibilities in counselling, prescription validation, and direct stewardship interventions. Pharmacists described themselves as custodians of antimicrobial safety, engaging in counselling, prescription validation, and direct AMS interventions. (2) Patients’ demands and socio-cultural practices: self-medication, reliance on family advice, and prior antibiotic experience drove inappropriate use. (3) Systemic and structural challenges, including weak regulatory enforcement, widespread antibiotic sales by patent medicine stores, and limited government support, undermined AMS efforts. As one participant explained: ‘You try to explain, but most people just want quick relief. If you refuse, they go to another pharmacy or even a patent medicine store.’ (4) Towards strengthening AMS: pharmacists recommended stronger interprofessional collaboration, continuous professional training, public education campaigns, stricter regulation of antibiotic sales, and adaptation of international AMS models to Nigeria’s context. Conclusion This study offers valuable insights into the roles of community pharmacists and the challenges they face in delivering AMS efforts in Nigeria, providing relevant guidance to inform policy and practice. Pharmacists reported engaging in counselling, prescription validation, and direct stewardship interventions, but were constrained by patient-driven demands, weak regulatory enforcement, and the widespread sale of antibiotics by unregulated outlets. The findings are limited to experiences of community pharmacists working in FCT, Abuja and may not capture the full diversity of practice in Nigeria. Future research can focus on expanding to a wider geographical area and incorporating perspectives from patients, prescribers, and policymakers to build a more comprehensive understanding of AMS in Nigeria.