Antimicrobial use and resistance in Nigeria: situation analysis and recommendations, 2017

Introduction : it is projected that by 2050, 40% of 10 million deaths from Antimicrobial Resistance (AMR) will occur in Africa. Understanding the AMR situation in Nigeria will provide an excellent case study of the challenges faced by low-income countries. Methods : the information was derived from review of reports, programmatic data and documents, literature search, key informant interviews and a series of systematic reviews. Data was entered into purpose-built templates and synthesized thematically. Results : in Nigeria, the ratio of licensed pharmacies to over-the-counter medicine stores was 15 to 1 in 2016. A systematic review determined that median prevalence of persons using antibiotics without prescription to be 46.8%. In animals, antibiotics such as tetracyclines constituted over 80% of antimicrobials sold or used in 2014 and 2015. Antibiotic resistance was documented in humans, to drugs recommended by the country’s treatment guidelines for commonly occurring infections such as cholera and cerebrospinal meningitis. Majority of the studies documented recovery E. coli, non-typhoidal Salmonella and antibiotic residues from livestock, pets and animal products, most commonly in poultry. The drivers of AMR included unregulated antibiotic sales, proliferation of unlicensed medicine stores, shortage of licensed prescribers, poor AMR awareness and use of antibiotics in animals without prescription. Conclusion : we recommend that the government enforce regulations on antibiotic sales of antibiotics to humans and animals and increase awareness on AMR in Nigerian communities. Identified gaps from the situation analysis were used to develop a National Action Plan for AMR.