As World Antimicrobial Resistance Awareness Week takes place from November 18–24, 2025, under the global theme “Act Now: Protect Our Present, Secure Our Future”, Nigeria finds itself at a critical turning point. Antimicrobial resistance is no longer a distant threat; it is already a daily reality, undermining our healthcare system and threatening countless lives.
Nigeria bears a heavy burden: more than 260,000 deaths in 2019 were linked to AMR, and the problem persists amid soaring rates of sepsis, especially in infants and underserved communities. One of the most dangerous drivers of AMR in Nigeria is the widespread, unregulated over-the-counter sale of antibiotics.
From pharmacies and chemist shops to informal markets, people can easily purchase powerful antibiotics, such as amoxicillin, ciprofloxacin, tetracycline, and metronidazole, without prescriptions or any medical oversight. Despite the National Agency for Food and Drug Administration and Control classifying antibiotics as prescription-only medications, enforcement remains minimal, creating a gap between policy and practice that allows resistant pathogens to thrive.
This access fuels rampant misuse. Nigerians self-medicate for malaria, coughs, diarrhoea, or vague “body pains”, often stopping antibiotic courses after just two or three tablets. This behaviour leads to sub-therapeutic exposure, allowing bacteria to adapt and become resistant. Compounding the problem is the proliferation of counterfeit and substandard drugs in informal markets, along with economic barriers that make clinic visits more expensive than a quick trip to a chemist. In addition, there is a lack of public awareness. Many still believe antibiotics are universal “cure-all” medicines rather than targeted treatments, and the result is a perfect storm for resistance to spread. The consequences are already severe. Hospitals report resistance rates of 67.8 per cent for methicillin-resistant Staphylococcus aureus and 28.6 per cent for carbapenem-resistant Enterobacterales, far exceeding global averages. An estimated 60,000 Nigerians die annually from AMR-related infections, a toll that persists year after year, draining our fragile healthcare system and threatening to reverse decades of progress in public health.
NAFDAC’s efforts deserve recognition. The agency has conducted increased market surveillance, issued public alerts about dangerous or substandard drugs, and cracked down on open drug markets in cities like Lagos, Kano, and Onitsha. Yet the persistence of over-the-counter antibiotic sales highlights a clear enforcement gap.
For real change, these efforts must evolve from one-off actions into a long-term, integrated strategy. To close this gap, Nigeria needs a bold, scalable reform initiative. First, NAFDAC should launch a national “Prescribe to Protect” campaign during AMR Week, focusing on high-risk antibiotics like amoxicillin, ciprofloxacin, and azithromycin. This campaign should include a simple digital platform that enables pharmacists and medicine vendors to verify prescriptions in real-time, helping to curb irrational sales while tracking antibiotic distribution trends. Building on that, renewal of pharmacy and patent medicine shop licenses should be tied to compliance with prescription-only rules, with regular audits, spot checks, and tiered penalties, including fines or temporary suspensions, for violators. On the flip side, vendors who comply should be rewarded with priority access to verified supplies and reduced renewal costs. Furthermore, NAFDAC should partner with the Pharmacists Council of Nigeria, the Association of Community Pharmacists, the Nigerian Association of Patent and Proprietary Medicine Dealers, and local authorities to deploy community-based enforcement teams. These units can educate, monitor, report violations, and help vendors transition away from risky practices. Antibiotic cartons and blister packs should carry prominent “prescription-only” warnings to empower consumers and discourage illegal sales.
Equally important is public education. Radio messages in local languages, market-day outreach, and social media campaigns must emphasise that antibiotics do not treat infections like malaria or the common cold. Finally, NAFDAC must accelerate efforts to formalise drug distribution, retrain patent and proprietary medicine vendors, establish regulated zonal pharmacies, and phase out open-market sales. By shifting antibiotic access to regulated outlets, we reduce the flow of unregulated products and limit opportunities for misuse. AMR is not waiting for us to catch up, but with decisive steps, digital verification, enforcement incentives, public engagement, and market reform, I believe Nigeria can turn the tide. The future of our antibiotics and our health depends on bold action now.
