Antibiotic stewardship sounds like a hospital programme, but for most patients it happens at a pharmacy counter in under two minutes. A request for an antibiotic raises three decisions: whether to dispense at all, what to ask and explain, and when to send the customer to a prescriber. This article sets out a practical way to handle each one, using current guidance and the evidence on what works.
It is a practice guide for dispensing staff, not individual medical advice. Treatment choices and doses belong in the current national guidelines and with the prescriber.
Decision one: should this be dispensed at all?
Start with the legal position, because it differs by product and by outlet. The Pharmacy Council of Tanzania tightened its regulations in February 2026, and Mfamasia’s report on the changes says they clarify which medicine categories can be dispensed at different levels of practice, including by ADDOs (Accredited Drug Dispensing Outlets). Owners and supervising pharmacists should check the current text against their own stock lists instead of relying on habit.
The reason this matters shows in the research. In a 2019 study across three regions, only 11.7% of sellers asked questions or gave advice when a customer asked for an antibiotic without a prescription, and fewer than 1.5% asked for one.
Decision two: what does the customer actually need?
Ask before you sell. Who is the medicine for? What are the symptoms, and for how long? Is the person already taking other medicines, and are they pregnant or a young child? The answers tell you whether this is a case for dispensing against a prescription, for referral, or for neither.
Many infections do not need an antibiotic. The WHO antibiotic book says so directly: it recommends first and second choice antibiotics for common infections and also covers when to manage them without antibiotics, since many upper respiratory infections are mostly viral or self-limiting. That judgement belongs to a prescriber, which is why a referral is often the right outcome of the conversation.
Use the AWaRe groups as a counter tool
WHO’s AWaRe system sorts antibiotics into three groups. Access antibiotics are usually first or second choice for common infections and rarely drive resistance. Watch antibiotics have a broader spectrum, cost more and contribute disproportionately to resistance. Reserve antibiotics are last-resort drugs for multidrug-resistant infections.
At the 2024 UN General Assembly, countries committed to making Access antibiotics at least 70% of use by 2030. A WHO report from April 2025 found that only one in three reporting countries, territories and areas meets that target, based on 2022 data.
Tanzania has its own list. According to Mfamasia’s coverage of the seventh STG-NEMLIT, the 2025 National AWaRe List draws on Tanzanian resistance and consumption data for 2020 to 2023 and classifies 70 antibiotics, up from 54. A pharmacy can use it in three simple ways:
- Mark each antibiotic in stock with its group.
- Review which Watch antibiotics sell most, and why.
- Make sure staff know the group of any antibiotic before they discuss it.
Make the conversation routine
A fixed routine helps when a customer pushes back. Explain that the rule protects the customer as well as the pharmacy. Offer a route to a prescriber instead of a flat refusal. When an antibiotic is dispensed against a prescription, repeat the prescriber’s instructions on how and for how long to take it. In a Tanzanian interview study of 28 dispensers, most admitted giving little detail on how to take antibiotics.
Keep records of what was dispensed and against which prescription. Records protect staff in a dispute and give the owner a view of antibiotic sales over time.
Does training at the counter work?
Partly. A systematic review of community pharmacist-led interventions included 17 studies covering 3,822 patients, most testing education. Over-the-counter antibiotic supply fell by up to 53% and symptom assessment improved, with up to 30% more advice given. Effects on patient adherence were mixed. The authors judged the interventions not sufficiently effective as currently implemented, and every included study had an unclear or high risk of bias.
The same Tanzanian interview study found that dispensers cited customer pressure, the need to keep a business running and patients’ low purchasing power. Training matters, but it works best when the whole outlet follows one written policy, so that no individual dispenser carries the commercial risk of saying no.
A short checklist for owners
- Check current regulations against your stock and your outlet type.
- Write one counter policy for antibiotic requests and train every member of staff on it.
- Group your antibiotic stock by AWaRe category.
- Keep dispensing records and review them each quarter.
- Agree where customers should be referred when they need a prescriber.
