Antibiotics lose their power when they are used carelessly, and much of that use is decided at the pharmacy counter. The best available evidence from Tanzania shows a wide gap between the rules on prescription-only antibiotics and what happens when a customer simply asks for one. Closing that gap is one of the most practical things pharmacy professionals can do to keep these medicines working.
What antimicrobial resistance means in daily practice
Antimicrobial resistance (AMR) occurs when bacteria and other microbes change so that medicines that once treated them stop working. Every unnecessary or incomplete course of an antibiotic adds to that pressure.
The scale is large. A global analysis published in The Lancet in September 2024 estimated that bacterial AMR was directly responsible for about 1.14 million deaths in 2021 and associated with about 4.71 million. The same study forecast about 1.91 million attributable and 8.22 million associated deaths a year by 2050. These are worldwide estimates, not Tanzanian figures.
Tanzania’s Chief Medical Officer told the Daily News in February 2026 that deaths associated with AMR had fallen by 10 percent. The report gave no baseline year or method, so it is best read as an official statement and not an independent measurement. The country’s second national action plan on AMR covers 2023 to 2028.
What happens at the counter
A study known as HATUA sent trained fieldworkers posing as customers to ask for amoxicillin without a prescription. Between April and July 2019 they visited 1,148 community pharmacies and Accredited Drug Dispensing Outlets (ADDOs) in Mwanza, Mbeya and Kilimanjaro. The published results were stark:
- 88.2% of outlets dispensed an antibiotic without a prescription.
- 87.2% sold a half course when asked.
- Only 11.7% of sellers asked questions or gave advice, and fewer than 1.5% asked for a prescription.
Community pharmacies were not exempt. In Mwanza the difference between pharmacies and ADDOs was not significant, while in Mbeya and Kilimanjaro ADDOs dispensed without a prescription more often. In those two regions, 17.8% and 22.7% of pharmacies asked or advised on at least one item, compared with 8.1% and 5.2% of ADDOs.
Two cautions apply. The data come from three regions and one antibiotic request in 2019, and rules have changed since. The study shows a pattern, not the behaviour of every outlet today.
Why dispensers sell without a prescription
A qualitative study interviewed 28 dispensers from 12 community pharmacies and 16 ADDOs in the same three regions. Most admitted selling antibiotics without a prescription, selling incomplete courses and giving little detail on how to take them. They pointed to customer pressure, the financial need to keep a business running, and patients’ low purchasing power.
The authors concluded that rules and enforcement alone will not be enough. They recommended educating customers and addressing the wider conditions that drive demand, such as poverty and gaps in government health services. Dispensers are working under real commercial pressure, and any realistic response has to acknowledge it.
What pharmacy professionals can do
Nothing here replaces clinical judgement or the law. These are practical habits that follow from the evidence above.
- Ask before you sell. Find out who the medicine is for, what the symptoms are and how long they have lasted. Only 11.7% of sellers did this in the 2019 study.
- Follow the prescription-only rules. The Pharmacy Council of Tanzania tightened its regulations in February 2026, and Mfamasia’s report on the changes notes that poor dispensing can feed AMR.
- Dispense the quantity prescribed, and explain how and for how long to take it.
- Use the national AWaRe list when reviewing antibiotic stock. According to Mfamasia’s coverage of the seventh STG-NEMLIT, the 2025 list was built on Tanzanian resistance and consumption data for 2020 to 2023 and classifies 70 antibiotics, up from 54.
- Refer customers who need a prescriber, and keep records of what was dispensed.
What owners and employers can add
Individual dispensers find it hard to refuse a sale when the next outlet will accept it. Owners and employers can reduce that pressure by agreeing a written counter policy, training every member of staff on it and applying it in all branches. The HATUA authors called for continuing education on dispensing, particularly for ADDO providers, and for Ministry of Health awareness work aimed at both sellers and consumers.
The evidence is now several years old. A fresh mystery-client survey after the 2026 prescription rules would show whether practice at the counter has changed.
